Prior Authorization Representative

Clay County Medical Center; Clay Center (KS); On-site; USD 38,000 - 48,000; Full time

Job summary

Clay County Medical Center in Clay Center, KS, is seeking a Prior Authorization Representative to review scheduled patient services, determine authorization needs, and obtain approvals, while supporting billing and posting.

The role requires collaboration with clinical staff, payers, and internal departments, ensuring payer rules, HIPAA, and internal policies are followed. The position emphasizes accurate documentation and ongoing regulatory awareness.

Qualifications

• High School Diploma or GED required.
• Associate’s Degree or equivalent coursework preferred.
• Minimum 1 year of healthcare financial services, registration, or related experience.
• Typing speed of 30 WPM or greater preferred.

Responsibilities

• Deliver professional, courteous service to patients, staff, and external partners.
• Handle inquiries and concerns with discretion, diplomacy, and confidentiality.
• Maintain a positive demeanor in high-pressure situations.
• Identify services requiring prior authorization and obtain timely approvals.
• Assist with billing, posting, and resolution of unbilled encounters.
• Identify and report billing issues, system errors, or process gaps to management.
• Work collaboratively with clinical staff, payers, and internal departments.
• Communicate issues, data, and updates clearly and in a timely manner.
• Participate in team meetings, training, and process improvement efforts.
• Accurately document account activity.
• Ensure compliance with payer rules, HIPAA, and internal policies.
• Assist in updating departmental procedures and training materials as needed.
• Complete required training and attend educational opportunities.
• Stay current with payer regulations and authorization requirements.

Skills

Customer service

Communication

Prioritization

Math & analytics

MS Office & patient accounting systems

Typing 30 WPM

Education

High School Diploma or GED

Associate’s Degree or equivalent coursework preferred

1 year healthcare financial services/registration experience

Typing speed 30 WPM or greater preferred

Tools

Word processing

Spreadsheets

Patient accounting systems

Email

Internet applications

Job description

NOTICE TO APPLICANTS: Your application may be shared with other CCMC department managers for consideration of additional suited positions.

Position: Prior Authorization Representative

Location: Clay Center, KS

Job Id: 804

# of Openings: 1

Prior Authorization Representative

Summary

Responsible for reviewing scheduled patient services to determine prior authorization requirements and obtaining approvals. Provides support with insurance billing and posting while ensuring compliance with payer contracts, HIPAA, regulatory requirements, and the organization’s Code of Conduct. Performs additional duties as assigned.

Key Responsibilities

Customer Service

• Deliver professional, courteous service to patients, staff, and external partners
• Handle inquiries and concerns with discretion, diplomacy, and confidentiality
• Maintain a positive demeanor in high-pressure situations
• Identify services requiring prior authorization and obtain timely approvals
• Assist with billing, posting, and resolution of unbilled encounters
• Identify and report billing issues, system errors, or process gaps to management

Communication & Teamwork

• Work collaboratively with clinical staff, payers, and internal departments
• Communicate issues, data, and updates clearly and in a timely manner
• Participate in team meetings, training, and process improvement efforts

Quality & Compliance

• Accurately document account activity
• Ensure compliance with payer rules, HIPAA, and internal policies
• Assist in updating departmental procedures and training materials as needed

Professional Development

• Complete required training and attend educational opportunities
• Stay current with payer regulations and authorization requirements

Qualifications

Education & Experience

• High School Diploma or GED required
• Associate’s Degree or equivalent coursework preferred
• Minimum 1 year of healthcare financial services, registration, or related experience
• Typing speed of 30 WPM or greater preferred

Skills & Abilities

• Strong customer service and communication skills (verbal and written)
• Ability to prioritize work and make routine independent decisions
• Basic math and analytical skills
• Proficiency with Word processing, spreadsheets, patient accounting systems, email, and internet applications

All offers contingent upon a post offer physical, urine drug screen, and background check.