Prior Authorization Rep

Sullivan County Community Hospital; New York, Northern (NY, KY); Hybrid; USD 36,000 - 54,000; Full time

Job summary

Sullivan County Community Hospital is seeking a Prior Authorization Representative to join our well‑established Revenue Cycle team in Sullivan, IN. The role focuses on verifying insurance, documenting payer policies, and ensuring prior authorizations are processed quickly and accurately.

You will work with physicians, HIM, IT, and patient financial services to resolve denials and improve authorization workflows. Strong attention to time constraints and minimal supervision are essential.

Qualifications

• High school diploma or equivalent required.
• 1 year of patient access, medical billing, or prior authorization experience preferred.
• Knowledge of medical terminology and CPT/HCPCS/ICD-10 coding.
• Proficiency with Meditech and MS Excel expected.

Responsibilities

• Verify insurance eligibility and benefits with payer or payer website before authorization.
• Document payer policies and procedures for coverage and required prior approvals.
• Ensure Medicare diagnosis support service and frequency guidelines are followed when applicable.
• Manage daily work queues to submit prior authorizations timely and accurately.
• Notify ordering physician’s office and patient of authorization status (approval/denial).
• Follow up with payers on status of prior authorizations.
• Identify denial trends and opportunities for process improvement with Revenue Cycle leadership.
• Implement payer-specific checklists for eligibility, benefits, and authorization.

Skills

Patient access

Medical terminology

Coding knowledge (CPT/HCPCS/ICD-10)

Meditech

MS Excel

Collaboration

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

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