Prior Authorization Specialist – Healthcare Access

Aiken Regional Medical Centers; Aiken, Northern (SC, KY); Hybrid; USD 45,000 - 60,000; Full time

Benefits offered by this job

Competitive pay

Excellent health plans

Tuition reimbursement

401(k) with match

Career development opportunities

Job summary

Aiken Regional Medical Centers in Aiken, South Carolina, seeks a Pre-Authorization Specialist to identify and obtain prior authorizations for scheduled and add-on services. You will verify coverage, document in CERNER, and communicate results to physicians to prevent denials and improve satisfaction.

The role requires knowledge of insurance processing and payer requirements, with a focus on timely authorization and peer-to-peer support when needed.

Qualifications

• Associate degree in business or related field preferred and/or 5 years or more of directly related experience performing same or similar job function.
• CHAA - Certified Healthcare Access Associate certification preferred.
• Five (5) years' experience in a health care facility or equivalent position performing same or similar job duties required.
• Medical Terminology completion preferred, understanding of third-party payer requirements (Authorization, verification and regulations).
• Ability to receive and express detailed information through oral and written communication.

Responsibilities

• Locates, reviews and obtains appropriate chart documentation from all sources (Physician, CERNER, etc.) based on payer requirements needed to obtain prior authorization for scheduled/ add-on IP and OP procedures/admissions/surgeries.
• Communicates with physician office regarding status of authorization, information needed, facilitates, and completes peer-to-peer reviews when needed.
• Initiate appeals for denied authorizations prior to service rendered avoiding denials and/or penalties to the facility.
• Understands Insurance processing requirements i.e.; (verification, authorization, terms, requirements and regulations) and familiar with payer processes to obtain authorization in a timely manner.

Skills

Communication skills

Detail oriented

Healthcare familiarity

Education

Associate degree in business or related major

CHAA certification

Tools

CERNER

Job description

Aiken Regional Medical Centers in Aiken, South Carolina, seeks a Pre-Authorization Specialist to identify and obtain prior authorizations for scheduled and add-on services. You will verify coverage, document in CERNER, and communicate results to physicians to prevent denials and improve satisfaction.

The role requires knowledge of insurance processing and payer requirements, with a focus on timely authorization and peer-to-peer support when needed.