Prior Authorization Specialist (Full-Time)

Pender Community Health; Pender (NE); On-site; USD 38,000 - 48,000; Full time

Benefits offered by this job

Health Insurance

Life Insurance

PTO

403(b) Retirement

Medical Savings Accounts

Dependent Care Savings Accounts

Group Incentive Plan

Job summary

Pender Community Health is seeking an entry-level Prior Authorization Specialist to support timely patient care by securing insurance approvals for procedures and hospital admissions. This role requires knowledge of health insurance plans, ICD/CPT coding, and EMR systems, with strong organizational and communication skills to coordinate with patients, physicians, and payers.

The position offers a standard full-time schedule and benefits.

Qualifications

• High school diploma or equivalent.
• Experience in insurance verification or prior authorizations.
• Familiarity with health insurance plans, ICD/CPT coding, and EMR systems.
• Strong organizational and customer service skills.
• Proficient in computer navigation, word processing, and email.

Responsibilities

• Contact patient insurance companies to verify patient insurance and benefits for scheduled services and hospital admissions
• Obtain, process and document prior authorizations in the EMR including authorization numbers, CPT codes, diagnosis, and approval dates
• Submit supporting medical records and necessary information to payer authorization representatives via fax, phone, or online portals
• Stay up to date with payer trends for prior authorizations
• Prioritize workload to ensure urgent cases are handled in a timely manner
• Ensure timely and accurate insurance authorizations are in place prior to services being rendered
• Maintain accurate payer website information and logins
• Communicate regularly with other departments and educate staff on authorization needs
• Develop and maintain working relationships with external agencies and specialty providers
• Explain notice of non-coverage or offers to reschedule elective tests and procedures, when patient pre-authorization is not obtained; notify patient and physician of outcome
• Ensure urgent/emergent cases are worked within one business day & elective cases prior to date of service
• Serve as liaison to hospital departments, physician offices, and patients for authorization or financial responsibility questions
• Facilitate authorization process with offices and providers
• Obtain clinical information from physician offices and HIM for CPT/ICD-10 codes
• Monitor prior authorization outcomes and maintain awareness of approvals and any denials resulting from inaccurate or incomplete information, communicating with Patient Accounting and the Revenue Cycle Action Team as needed.
• Connect patients/guarantors to Financial Counselor for estimates
• Maintain professional growth through seminars, workshops, and affiliations
• Participate in meetings, committees, and department projects as needed

Skills

Insurance verification

Prior authorizations

EMR systems

ICD/CPT coding

Customer service

Administrative tasks

Education

High school diploma or equivalent

Job description

Prior Authorization Specialist (Full-Time)

• Job Tracking ID:26-45-ADM-H
• Job Level:Entry Level (less than 2 years)

The Prior Authorization Specialist plays a critical role in aneffective prior authorization program. This position ensurespatients receive timely and appropriate medical services by securinginsurance approvals for procedures, treatments, and hospitaladmissions. This position requires a deep understanding ofinsurance guidelines, medical terminology, and healthcare workflowsto facilitate efficient and accurate authorization processes.

ESSENTIAL JOB DUTIES & RESPONSIBLITIES

• Contact patient insurance companies to verify patientinsurance and benefits for scheduled services and hospital admissions
• Obtain, process and document prior authorizations in theelectronic medical record (EMR) including authorization numbers,CPT codes, diagnosis, and approval dates
• Submit supporting medical records and necessary information topayer authorization representatives via fax, phone, or online portals
• Stay up to date with payer trends for prior authorizations
• Prioritize workload to ensure urgent cases are handled in atimely manner
• Ensure timely and accurate insurance authorizations are inplace prior to services being rendered
• Maintain accurate payer website information and logins
• Communicate regularly with other departments and educate staffon authorization needs
• Develop and maintain working relationships with externalagencies and specialty providers
• Explain notice of non-coverage or offers to re-scheduleelective tests and procedures, when patient pre-authorization isnot obtained; notify patient and physician of outcome
• Ensure urgent/emergent cases are worked within one businessday & elective cases prior to date of service
• Serve as liaison to hospital departments, physician offices,and patients for authorization or financial responsibility questions
• Facilitate authorization process with offices and providers
• Obtain clinical information from physician offices and HIM forCPT/ICD-10 codes
• Monitor prior authorization outcomes and maintain awarenessofapprovals and any denials resulting from inaccurate or incompleteinformation, communicating with Patient Accounting and the RevenueCycle Action Team as needed.
• Connect patients/guarantors to Financial Counselor for estimates
• Maintain professional growth through seminars, workshops, and affiliations
• Participate in meetings, committees, and department projectsas needed

Hours:Minimum 40 hours/week; Monday-Friday 8:00am- 4:30pm

Experience and Skills

Education, Experience:

• High school diploma or equivalent
• Experience in insurance verification or prior authorizations
• Familiarity with health insurance plans, ICD/CPT coding, andEMR systems
• Strong organizational and customer service skills
• Proficient in computer navigation, word processing, and email

GENERAL REQUIREMENTS

• Basic math and reading comprehension
• Ability to use computer systems and write reports
• Adaptability and problem-solving skills
• Strong interpersonal and communication abilities

EQUIPMENT, TOOLS, MATERIALS

• Knowledge of relevant computer hardware and software

Standard full-time benefits:Benefits go into effect on the 1st of the month following 30 days of employment. Include but not limited to:

• Health Insurance:PPO and H.S.A. option; PCH paysa portion of premiums
• Life Insurance:Life and Accidental Death and Dismemberment Plan at no cost to the employee; opportunity topurchase additional coverage also available
• Paid Time Off (PTO):Accrue hours based on apercentage rate (set by years of service) multiplied by the numberof hours worked in a pay period
• 403(b) Retirement:The hospital will matchemployee contributions for their retirement, up to a percentageemployee gross wage
• Medical and Dependent Care Savings Accounts
• Group Incentive Plan (GIP):The hospital setsfacility wide goals for our annual fiscal year. Depending on howmany of those goals we meet at the end of the fiscal year thatdetermines the amount of bonus employees receive.

This institution is an EEO/AA Employer and Provider - ProtectedVeterans and Individuals with Disabilities.