Prior Authorization Specialist - Healthcare Access

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

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.