Prior Authorization Rep

Sullivan County Community Hospital; Benefiel Corner (IN); On-site; USD 38,000 - 52,000; Full time

Job summary

Sullivan County Community Hospital is seeking a Prior Authorization Representative to join the clerical team in Sullivan, IN. The role supports patient access workflows, verifies payer coverage, and manages authorization queues with accuracy and timeliness.

The ideal candidate has at least one year of related experience, strong medical terminology knowledge, and proficiency with Meditech and MS Excel. Collaborative, organized, and adaptable candidates will thrive in this environment.

Qualifications

• High school diploma or equivalent required.
• One year of patient access, medical billing, or prior authorization experience.
• Solid knowledge of medical terminology and CPT/HCPCS/ICD-10 coding.
• Proficiency with Meditech and Excel; able to collaborate across departments.

Responsibilities

• Verify insurance eligibility and benefits with payers or payer websites prior to authorization.
• Document payer policies and procedures for coverage and prior approval requirements.
• Ensure Medicare diagnosis support and frequency guidelines are not exceeded.
• Manage daily work queues to submit authorizations timely and accurately.
• Notify ordering physician and patient of authorization outcomes.
• Follow up with payers on status of prior authorizations.
• Identify denial trends with Revenue Cycle leadership and suggest process improvements.
• Implement payer-specific checklists for eligibility, benefits, and authorization.

Skills

Patient access

Medical billing

Prior authorization

Medical terminology

CPT/HCPCS/ICD-10 coding

Meditech

MS Excel

Collaboration across teams

Time management

Adaptability

Education

High school diploma or equivalent

Tools

Meditech

MS Excel

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Prior Authorization Rep

Full Time Clerical Sullivan, IN, US

2 days ago Requisition ID: 1551

QUALIFICATIONS

Education

• High school diploma or equivalent

Experience/Skills

• Has one year patient access, medical billing, or prior authorization experience
• Possesses medical terminology and CPT/HCPCS/ICD-10 coding knowledge
• Demonstrates proficiency in Meditech and MS Excel
• Professionally collaborates with staff at various levels throughout the organization, including, but not limited to: Physician Practices, HIM, Information Systems, Patient Financial Services and Clinical Directors
• Works efficiently with minimal supervision
• Remains flexible to accommodate staffing shortages in the Patient Access department

Required Licenses/Certifications

• N/A

Working Conditions

• Works in a well-ventilated, well-lit general office environment
• Works well under pressure with attention to time constraints

ROUTINE RESPONSIBILITIES

• Consistently complies with established Behavioral Expectations
• Verifies insurance eligibility and benefits directly with payer or on payer Website prior to starting the authorization process
• Identifies and documents each payer policy and procedure regarding coverage and items that require prior approval
• When applicable, verifies that Medicare diagnosis support service and frequency guidelines are not exceeded
• Manages daily work queues to ensure prior authorizations are submitted timely and accurately
• Ensures that notification of authorization approval or denial is communicated timely to the ordering physician’s office and to the patient
• Follows up with payers to check status of previously submitted prior authorizations
• Works directly with Director of Revenue Cycle to identify trends in denials and opportunities for improvement in the authorization process
• Implements a payer-specific check list for eligibility, benefits, and authorization to cover pre-financial clearance