Prior Authorization Rep

Sullivan County Community Hospital; Sullivan (IN); On-site; USD 38,000 - 48,000; Full time

Job summary

Sullivan County Community Hospital is seeking a Prior Authorization Representative for a full-time clerical role in Sullivan, IN. The position involves confirming patient eligibility, processing prior authorizations, and ensuring timely communication with physicians and patients.

The ideal candidate will have at least one year of related experience, knowledge of CPT/HCPCS/ICD-10 coding, and proficiency in Meditech and MS Excel, enabling efficient coordination with departments across the

Qualifications

• High school diploma or equivalent required.
• Experience with patient access, medical billing, or prior authorization preferred.
• Knowledge of CPT/HCPCS/ICD-10 coding is advantageous.

Responsibilities

• Verifies insurance eligibility and benefits with payer or payer website prior to starting the authorization process.
• Identifies payer policies for coverage and items requiring prior authorization.
• Ensures Medicare diagnosis support service and frequency guidelines are not exceeded when applicable.
• Manages daily work queues to submit prior authorizations timely and accurately.
• Notifies ordering physician’s office and patient about approval or denial of authorizations promptly.
• Follows up with payers to check status of previously submitted prior authorizations.
• Collaborates with the Director of Revenue Cycle to identify trends in denials and opportunities for improvement in the authorization process.
• Implements payer-specific checklists for eligibility, benefits, and authorization to cover pre-financial clearance.

Skills

Patient access

Medical billing

Prior authorization

Medical terminology

CPT/HCPCS/ICD-10 coding

Meditech

MS Excel

Team collaboration

Independent work

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