Prior Authorization Specialist

RiseMe; Greencastle (IN); On-site; USD 36,000 - 54,000; Full time

Job summary

Putnam County Hospital in Greencastle, IN is seeking an Prior Authorization Specialist to manage authorization workflows across primary care clinics. You will obtain authorizations, coordinate with payors, and ensure accurate patient data and clinical information is provided to support timely reimbursement.

Ideal candidates will have strong communication, organizational skills, and experience with CPT/ICD-10 coding within a healthcare setting, while upholding patient confidentiality and

Qualifications

• Experience with prior authorizations for imaging and procedures.
• Knowledge of payer requirements and insurance verification.
• Experience with CPT and ICD-10 coding for medical necessity.
• Healthcare setting experience preferred.

Responsibilities

• Obtain prior authorizations for imaging and procedures.
• Maintain documentation on prior authorizations to support timely care.
• Ensure accurate patient registration including demographics and insurance.
• Assemble clinical information for referrals and communications with payors.
• Coordinate with review organizations and insurers to meet requirements.
• Assist with referrals and ensure HIPAA compliance.

Skills

Customer service

Communication

Teamwork independence

Time management

Prioritization

Problem solving

Initiative

Professional conduct

Attention to detail

Medical terminology

Job description

Job Details: Job Location: PUTNAM COUNTY HOSPITAL - GREENCASTLE, IN, Salary Range: Undisclosed, Job Shift: Day, Job Summary: The prior authorization specialist is responsible for prior authorization operations within the primary care clinics, establishing and standardizing systems and procedures for the distribution and use of health information throughout the organization, coordinating prior authorization functions with all other departments. Job Duties: Obtain prior authorizations for imaging and procedures from appropriate payors. Maintain ongoing tracking and appropriate documentation on prior authorizations to promote team awareness and ensure patient safety Ensure complete and accurate registration, including patient demographic and current insurance information Assemble information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist- Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis and prognosis. Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians Review details and expectations about the prior authorization with patients as needed Ensure that prior authorizations are addressed in a timely manner Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers Abide by HIPPA and Hospital policies & procedures Assists with Referrals as needed Performs other duties as assigned Qualifications: Job Requirements:

• Strong customer service focus
• Strong verbal and written communication skills
• Able to work as part of a team and independently
• Strong organizational and time management skills
• Able to prioritize effectively including medical triage prioritization
• Good judgement, resourcefulness, and problem solving abilities
• Able to take initiative and follow through with delegated tasks
• Able to act with integrity, professionalism, and confidentiality
• Strong attention to detail
• Strong proficiency in medical terminology & abbreviations
• Knowledge of prior authorizations process for different services (radiology, pharmacology & laboratory services) and insurance providers (commercial, Medicare & Medicaid), solid understanding and knowledge of payer contractual requirements, experience with insurance verification, experience and familiarity with using insurance portals
• Previous clinical support experience in a healthcare setting with basic knowledge of CPT & ICD 10 codes, working knowledge of anatomy, physiology & the disease process to effectively communicate medical necessity criteria for procedures ordered or to effectively appeal an adverse determination