Prior Authorization Specialist

Hartford HealthCare; Manchester (CT); On-site; USD 42,000 - 54,000; Full time

Job summary

Hartford HealthCare is seeking an insurance authorization specialist in Manchester, CT. The role requires ensuring precertifications and authorizations are in place for outpatient services, working with FCC, ASC scheduling and physician offices to prevent denials and improve cash flow.

The ideal candidate has a High School diploma (Associate’s degree preferred), 2 years in hospital or medical office insurance/authorization experience, and strong English communication skills for coordinating care

Qualifications

• High School degree required.
• Associate’s degree preferred.

Responsibilities

• Obtain and document insurance eligibility and benefits in ADT system.
• Obtain authorizations prior to date of service, coordinating with physicians’ offices.
• Verify coverage, manage pre-authorizations to prevent denials and ensure payment.
• Assign CPT and diagnostic codes (CPT/ICD-9CM/ICD-10) in billing system.
• Communicate with Case Management and Behavioral Health to secure necessary authorizations.
• Ensure accurate insurance information and referrals on patient accounts.

Skills

Insurance knowledge

CPT/ICD-10 codes

Medical terminology

English communication

Customer service

Deadlines/fast-paced environment

Education

High School degree

Associate’s degree preferred

Tools

Meditech system

Job description

Hartford HealthCare is seeking an insurance authorization specialist in Manchester, CT. The role requires ensuring precertifications and authorizations are in place for outpatient services, working with FCC, ASC scheduling and physician offices to prevent denials and improve cash flow.

The ideal candidate has a High School diploma (Associate’s degree preferred), 2 years in hospital or medical office insurance/authorization experience, and strong English communication skills for coordinating care