Prior Authorization Specialist — Epic & Payer Expert

Lexington Health; Chartwell (SC); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Day ONE medical, dental and life ins.

403(b) match plan day one

Employer paid disability (after 90d)

Student loan forgiveness

Life insurance

Job summary

Lexington Health in South Carolina is seeking a referral and prior authorization specialist to ensure accurate authorizations before patient appointments. You will use Epic Referral Work Queues, Real Time Authorization, payer portals, and fax to process imaging and specialty referrals, keeping records updated in Epic.

The role requires attention to detail, familiarity with ICD-10 and CPT Coding, and strong knowledge of medical terminology and insurance workflows.

Qualifications

• High School Diploma or Equivalent.
• 6 months of referral and/or authorization experience.
• Strong Medical Terminology and Insurance Knowledge; ICD-10 and CPT Coding.

Responsibilities

• Understands the referral process start to finish and acknowledges authorization as an important step in the overall process.
• Meets authorization volume and quality standards set monthly.
• Thoroughly reviews patient charts in Epic, submits the appropriate clinicals for authorization to the correct payer/third party vendor, obtains final determination from payer and enters information into EPIC.
• Utilizes Experian RTA system to obtain authorization and verifies authorization completion within system.
• Communicates all necessary authorization updates and status changes to the appropriate department(s).
• Communicates peer-to-peer requests to PN practices for providers/clinical staff to complete in order to obtain an authorization from payer.

Skills

Medical Terminology

Insurance Knowledge

ICD-10 & CPT Coding

Epic EHR

Attention to detail

Communication skills

Education

High School Diploma or Equivalent

Tools

Epic EHR

Experian RTA

Job description

Lexington Health in South Carolina is seeking a referral and prior authorization specialist to ensure accurate authorizations before patient appointments. You will use Epic Referral Work Queues, Real Time Authorization, payer portals, and fax to process imaging and specialty referrals, keeping records updated in Epic.

The role requires attention to detail, familiarity with ICD-10 and CPT Coding, and strong knowledge of medical terminology and insurance workflows.