PRIOR AUTHORIZATION SPECIALIST

Valor Health; Emmett (ID); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Valor Health in Emmett, Idaho seeks a Prior Authorization Specialist to manage pre-certifications and authorizations, verify insurance eligibility, and help shape efficient workflow across the care team. You will collaborate with billing and clinical staff, ensure medical necessity documentation is complete, and track pending approvals to speed patient care in a hybrid work setting.

Requirements include a high school diploma, 3 years in healthcare, 2 years MA/CAN/LPN, and proficiency with Word,

Qualifications

• High school diploma or equivalent.
• 3 years’ experience working in healthcare.
• 2 years’ experience as a Medical Assistant/CAN/LPN.
• Preferred experience with obtaining prior authorizations.
• Ability to communicate effectively with a wide variety of contacts at all levels of the organization.
• Strong organizational skills and attention to detail.
• Strong work ethic and ability to apply critical thinking to time-sensitive situations.
• Proficiency with Microsoft Office including Word, Excel, and Outlook.

Responsibilities

• Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements.
• Request, follow up and secure prior authorizations prior to services being performed.
• Prioritize incoming authorization requests according to urgency.
• Collaborate with other departments to assist in obtaining prior authorizations in a cross-functional manner.
• Work with billing specialist to obtain a retro authorization.
• Assist with medical necessity documentation and submit medical records to expedite approvals.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present.
• Responsible for reviewing all encounters and mailing out Consolidated Summary of.
• Attends and participates in meetings as requested.
• Performs other duties as assigned.

Skills

Communication

Organization

Attention to detail

Critical thinking

Teamwork

Adaptability

Education

High school diploma or equivalent

Tools

Word

Excel

Outlook

Job description

Position Title: Prior Authorization Specialist

Department: Business Office

Supervisor’s Title: HIM/Business Office Manager

IHA# Position Summary:

Responsibilities

The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures performed at Valor Health. Developing and implementing prior authorization workflow, policies, and procedures. Principal Functions and Responsibilities:

• Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements.


• Request, follow up and secure prior authorizations prior to services being performed at Valor Health.


• Prioritize incoming authorization requests according to urgency.


• Collaborate with other departments to assist in obtaining prior authorizations in a cross-functional manner.


• When necessary, work with billing specialist to obtain a retro authorization.


• Assist with medical necessity documentation and submit medical records to expedite approvals and ensure that appropriate follow up is performed.


• Review accuracy and completeness of information requested and ensure that all supporting documents are present.


• Responsible for reviewing all encounters and mailing out Consolidated Summary of


• Attends and participates in meetings as requested.


• Performs other duties as assigned.

Qualifications

Position Qualifications/Requirements/preferences:

• Minimum Education: High school diploma or equivalent.


• Minimum of 3 years’ experience working in healthcare.


• Minimum of 2 years’ experience as a Medical Assistant/CAN/LPN


• Preferred experience with obtaining prior authorizations.


• Ability to communicate effectively with a wide variety of contacts at all levels of the organization.


• Must have strong organizational skills and attention to detail.


• Strong work ethic and ability to apply critical thinking to a variety of practical and time sensitive situations.


• Working knowledge of Microsoft Office including Word, Excel, and Outlook are required.


• Consistent professionalism in both presentation and demeanor.


• Ability to work with minimal supervision and as a member of a team.


• Ability to Flex Schedule to adjust to workflow.

Working Conditions

• Primarily office work. Positions is flexible to be in suite, remote or hybrid.


• General Health care environment exposure to patient conditions.


• Physical Requirements: Standing, walking, bending, stooping, sitting, hand eye coordination, speaking.