Prior Authorization Specialist — Healthcare Billing

St. Marys Medical Center; Huntington (WV); On-site; USD 40,000 - 52,000; Full time

Job summary

St. Mary's Medical Center is seeking an Authorization Coordinator to join our Scott Ortho team. This full-time role focuses on obtaining preauthorization, documenting CPT/diagnosis codes, and coordinating with insurance carriers to ensure timely procedures.

The ideal candidate has at least 1 year of billing or clinical experience in a health care setting and a high school diploma or equivalent. Strong communication and attention to detail are essential for success.

Qualifications

• High School diploma or equivalent.
• 1 year of billing or clinical experience in a health care organization preferred.

Responsibilities

• Utilizes the necessary electronic and manual systems to identify and capture source documentation needed for the coding of ordered procedures, injections, tests, surgeries, etc.
• Answers phone calls and//or inquiries from insurance carriers or other parties to assist in the prior authorization for scheduled procedures as necessary
• Performs the precertification process for scheduled procedures as necessary, including communication of any balances due to the patient
• Communicates and appropriately documents the details of the procedure authorization. Includes information such as approved CPT code, diagnosis code and date of service range to entity performing the procedure and documents details of authorization in the patient medical record per approved protocols
• Performs other duties as assigned or requested
• Works directly with VA and Workers' Comp. case workers to obtain authorizations and claim numbers for procedures, testing, injections and surgery.

Education

High School diploma or equivalent

Job description

St. Mary's Medical Center is seeking an Authorization Coordinator to join our Scott Ortho team. This full-time role focuses on obtaining preauthorization, documenting CPT/diagnosis codes, and coordinating with insurance carriers to ensure timely procedures.

The ideal candidate has at least 1 year of billing or clinical experience in a health care setting and a high school diploma or equivalent. Strong communication and attention to detail are essential for success.