Prior Authorization Specialist, Full-time

Cumberland Healthcare (Cumberland Memorial Hospital); Cumberland (ME); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Competitive wage and benefits

Job summary

Cumberland Healthcare in Maine is seeking a Prior Authorization Specialist to join our team. The role centers on obtaining prior authorizations from insurance companies for healthcare providers and ensuring timely, accurate approvals.

This position requires verifying coverage, reviewing medical records, and assessing eligibility. Responsibilities include communicating with insurers, tracking cases, updating patient insurance information, managing work queues and denials, and supporting the

Qualifications

• Experience with prior authorizations required.
• Strong customer service and clerical skills.
• Experience working with insurance companies required.
• Education/experience working with Medical Terminology preferred.
• Knowledge of CPT and ICD-10 Coding.
• Advanced computer skills.
• Positive attitude in a fast-paced team environment.

Responsibilities

• Obtain prior authorizations from insurance providers.
• Verify insurance coverage and assess eligibility for services.
• Review medical records as part of the authorization process.
• Communicate with insurers and track cases.
• Update patient insurance information and manage work queues.
• Support the appeal process when denials occur.

Skills

Prior Authorization

Customer Service

Insurance Communication

Medical Terminology

CPT & ICD-10

Advanced Computer Skills

Team Player

Education

Medical Terminology knowledge preferred

Job description

Job Summary/Duties

Cumberland Healthcare is currently searching for a Prior Authorization Specialist to join our team. The primary duty of this team member would be obtaining prior authorizations from insurance companies for healthcare providers. This includes verifying insurance coverage, reviewing medical records Assessing eligibility for services, communicating with insurance providers, tracking cases, updating patient insurance, managing work queues and denials, and supporting the appeal process.

Experience

• Prior Authorization experience required
• Excellent Customer Service, communication and clerical skills
• Experience working with insurance companies required
• Education/experience working with Medical Terminology preferred
• Knowledge of CPT and ICD/10 Coding
• Advanced computer skills
• Positive attitude in a fast paced environment and a team player.

We offer a competitive wage and benefit package, as well as an exceptional working environment. In our latest Press Ganey Employee Engagement Survey, our team ranked in the 90th percentile amongst rural healthcare facilities when it came to work-life balance. Join our team today!