Prior Authorization Specialist

Siskiyou Community Health Center, Inc.; Grants Pass (OR); Presencial; USD 25 000 - 34 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical Insurance

Dental Insurance

Vision Insurance

Health Savings Account (HSA)

Flexible Spending Account (FSA)

403(b) Retirement Plan

Paid Time Off

Holiday & Paid Sick Time

Employee Assistance Program (EAP)

Mercy Flights Membership

Tuition Reimbursement & Professional  

Resumo da oferta

Siskiyou Community Health Center, Inc. in Grants Pass, OR is hiring a full-time Prior Authorization Specialist. You will coordinate and obtain authorizations for medications and imaging, and manage referrals to ensure timely patient access to care.

Responsibilities include submitting to CoverMyMeds, communicating with providers and insurers, and documenting all activity in the EHR. The role requires attention to detail, HIPAA compliance, and the ability to multitask in a fast-paced clinic

Qualificações

• High School Diploma or GED required.
• Healthcare/medical admin experience preferred.
• Experience with insurance and prior authorizations preferred.
• Familiarity with CoverMyMeds or similar platforms preferred.

Responsabilidades

• Process medication prior authorizations via CoverMyMeds and similar platforms.
• Coordinate prior authorizations for diagnostic imaging.
• Process and track imaging referrals with providers, insurers, and facilities.
• Review requests for accuracy and obtain missing documentation.
• Communicate authorization requirements and follow up on delays.
• Document all activities in the EHR accurately.
• Maintain organized records and prioritize requests.

Conhecimentos

Medical terminology

Insurance processes

Prior authorization

EHR familiarity

Time management

Communication

Multitasking

Problem solving

Formação académica

High School Diploma or GED

Ferramentas

CoverMyMeds

EHR systems

Descrição da oferta de emprego

Job Title: Prior Authorization SpecialistReports To: Health Information and Care Coordination ManagerLocation: Grants Pass, Oregon – 557B NE Westbrook Way Hawthrone Ave. Grants Pass, OR, 97527Job Type: Full TimeFLSA Status: Non-ExemptPay Range: $18.35-$25.00/hourSchedule: Monday-Friday 8:00 AM – 5:00 PMJob Summary:The Prior Authorization Specialist is responsible for coordinating and obtaining prior authorizations for medications and diagnostic imaging services, as well as processing imaging referrals. This role plays a key part in ensuring timely access to patient care by facilitating authorization requests, coordinating with insurance providers, and supporting an efficient referral process.Essential Functions:Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.Processes and monitors medication prior authorization requests through CoverMyMeds and other insurance authorization platforms.Coordinates prior authorizations for diagnostic imaging services, ensuring timely submission of required documentation.Processes and tracks imaging referrals, coordinating with providers, insurance companies, and imaging facilities to support timely patient care.Reviews authorization requests for accuracy and completeness, obtaining additional clinical documentation as needed.Communicates with providers and clinical staff regarding authorization requirements, pending requests, approvals, denials, and necessary follow-up.Follows up with insurance companies to resolve authorization delays, documentation discrepancies, and outstanding requests.Accurately documents prior authorizations, referral activities, and medication refill-related information in the Electronic Health Record (EHR).Maintains organized records and prioritizes requests to ensure timely processing and completion.Ensures compliance with HIPAA regulations, patient confidentiality standards, and organizational policies.Performs other duties as assigned..Working Conditions:Work Environment: 100% office-based position with continuous interaction with patients. Work is primarily conducted at a designated workstation utilizing computers, electronic health records, telephones, and other standard office equipment. Regular interaction with healthcare providers, clinical staff, insurance representatives, pharmacies, and external healthcare organizations is required. The position involves managing multiple requests and deadlines in a fast-paced healthcare environment while maintaining accuracy and attention to detail.Travel Requirements: Primarily office-based; occasional local travel may be required as needed.Physical Demands: Prolonged periods of sitting and working at a computer workstation. Frequent use of hands and fingers for typing, data entry, operating office equipment, and handling documents. Ability to stand, walk, sit, bend, reach, push, carry, and lift as required to perform job duties. Ability to maintain physical mobility throughout the office. Vision and hearing must be within functional range, with corrective devices as needed.QualificationsRequired Education and ExperienceEducation:High School Diploma or equivalent GED.Experience:Previous experience in a healthcare, medical office, pharmacy, or administrative support setting preferred.Experience processing medication prior authorizations, insurance verification, medical referrals, or insurance-related documentation preferred.Familiarity with Electronic Health Record (EHR) systems and healthcare documentation practices preferred.Experience working with insurance companies, including Medicaid, Medicare, and commercial insurance plans, preferred.Experience utilizing CoverMyMeds or similar prior authorization platforms preferred.Knowledge & SkillsKnowledge of medical terminology, medications, insurance processes, and prior authorization requirements.Familiarity with Electronic Health Records (EHR), CoverMyMeds, and standard computer applications.Strong organizational, time-management, and multitasking skills with attention to detail.Effective communication, customer service, and problem-solving skills.Ability to work independently and collaboratively in a fast-paced healthcare environment.Understanding of HIPAA regulations, patient confidentiality, and privacy requirements.Comprehensive Benefits PackageAt Siskiyou Community Health Center, we’re committed to supporting the health, financial well-being, and work-life balance of our employees. Our comprehensive benefits package includes:Medical, Dental & Vision InsuranceHealth Savings Account (HSA) & Flexible Spending Account (FSA)403(b) Retirement Plan & Retirement Savings OpportunitiesPaid Time Off, Holiday & Paid Sick TimeFamily LeaveEmployee Assistance Program (EAP)Life InsuranceEmployer paid Mercy Flights MembershipTuition Reimbursement & Professional Development SupportMileage ReimbursementPre-Employment Requirements: Employment is contingent upon successful completion of a post-offer background check, employment verification, and drug screening. The drug screening must produce a negative result for marijuana and other substances prohibited by the organization’s drug-free workplace policy.At-Will Employment: Siskiyou Community Health Center is an ‘At-Will’ employer. Nothing in this job description should be interpreted as an employment contract.