Prior Authorization Specialist

Mt. Graham Regional Medical Center; Arizona; On-site; USD 40,000 - 60,000; Full time

Job summary

Mt. Graham Regional Medical Center seeks a dedicated Prior Authorization Specialist to secure timely authorizations for services and ensure compliant reimbursement. You will review clinical data, liaise with payers, and document approvals in the EHR and billing systems to prevent denials.

The role requires strong communication, organization, and attention to detail, with a focus on accurate documentation and patient service.

Qualifications

• Must be at least 18 years of age.
• Education level: high school diploma or equivalent; associate/bachelor’s preferred.
• Build rapport with patients and provide excellent interpersonal communication.
• Organized and detail oriented; able to take direction.
• Understand insurance payors and detailed contracts; verify coverage.
• Review procedures to determine prior authorization necessity.
• Clear, proactive communication with providers, team members, and patients.
• Accurate documentation of authorization numbers and processes.

Responsibilities

• Secure timely insurance authorizations for scheduled and unscheduled services.
• Review clinical and insurance information; communicate with payers and internal stakeholders.
• Document authorization approvals accurately in the EHR and billing systems.
• Prevent authorization-related denials by thorough review and follow-up.
• Verify insurance coverage and eligibility; record details in systems.
• Collect co-pays and deductibles; ensure patient service satisfaction.

Skills

Rapport with patients

Interpersonal skills

Organized

Detail oriented

Follow directions

Written communication

Communication with payers

Documentation accuracy

Education

High school diploma or equivalent

Associate or bachelor's degree preferred

Tools

EHR systems

Billing software

Insurance payor contracts

Job description

Position Summary

The Prior Authorization Specialist is responsible for securing timely insurance authorizations for scheduled and unscheduled healthcare services to ensure reimbursement, regulatory compliance, and continuity of patient care. This role reviews clinical and insurance information communicates with payers and internal stakeholders, and documents authorization approvals accurately in the EHR and billing systems to prevent authorization-related denials.

Brief Description

Position Summary

The Prior Authorization Specialist is responsible for securing timely insurance authorizations for scheduled and unscheduled healthcare services to ensure reimbursement, regulatory compliance, and continuity of patient care. This role reviews clinical and insurance information communicates with payers and internal stakeholders, and documents authorization approvals accurately in the EHR and billing systems to prevent authorization-related denials.

Requirements

Required Qualifications

• Must be at least 18 years of age.
• Proof of highest level of education completed but not less than high school education or equivalent.
• High school diploma or equivalent required; associate or bachelor’s degree preferred.
• The ability to build rapport with patients is essential
• Personable, optimistic resilient, and possess exceptional interpersonal communication skills
• Organized and detail oriented.
• Ability to take direction and correction if needed
• Must understand all Insurance Payors and Detailed Contracts
• Verify insurance coverage and eligibility.
• Review of procedure orders and documentation to determine necessity of prior auth.
• Strong communication skills with providers, team members and patients
• Excellent written communication skills
• Detailed documentation of authorization numbers and process for each prior auth
• Collect co-pays and deductibles
• Excellent Customer Service

Preferred Qualifications

• Experience in hospital or multi-specialty practice setting
• Knowledge of CPT, ICD-10, and HCPCS codes
• Familiarity with Medicare, Medicaid, and managed care plans
• Certification such as CPAR, CPC, or CRCR (preferred but not required)

Summary

Traci Johns

1600 S 20th Ave. Safford, AZ 85546

Email: [e-mail]

Phone: [phone]