Prior Authorization Specialist – Epic & Payer Expert

Lexington Health; Columbia (SC); On-site; USD 40,000 - 52,000; Full time

Benefits offered by this job

Day ONE benefits

403(b) match plan

Employer paid life insurance

Tuition reimbursement

Student loan forgiveness

Disability coverage

Job summary

Lexington Health is a network of care serving the Columbia, SC area. The PN Access and Authorizations role is responsible for accurately authorizing referrals prior to patient appointments and utilizing Epic, Experian RTA, and payer websites to complete authorizations for imaging and specialty services.

The position requires strong medical terminology and insurance knowledge, with 6 months of related experience.

Qualifications

• High School Diploma or equivalent is required.
• 6 months of referral and/or authorization experience required.
• Strong medical terminology and insurance knowledge; knowledge of ICD-10 and CPT coding.

Responsibilities

• Understanding referral process from start to finish and ensuring authorization is completed accurately.
• Review patient charts in Epic and submit clinicals for authorization to the payer.
• Obtain final determinations from payers and update EPIC with approvals/denials.

Skills

Medical terminology

Insurance knowledge

ICD-10 & CPT coding

Education

High School Diploma or Equivalent

Tools

Epic Referral module

Experian Real Time Authorization (RTA)

Job description

Lexington Health is a network of care serving the Columbia, SC area. The PN Access and Authorizations role is responsible for accurately authorizing referrals prior to patient appointments and utilizing Epic, Experian RTA, and payer websites to complete authorizations for imaging and specialty services.

The position requires strong medical terminology and insurance knowledge, with 6 months of related experience.