Prior Authorization Specialist - Healthcare Billing

Sullivan County Community Hospital; Sullivan (IN); On-site; USD 38,000 - 48,000; Full time

Job summary

Sullivan County Community Hospital is seeking a Prior Authorization Representative for a full-time clerical role in Sullivan, IN. The position involves confirming patient eligibility, processing prior authorizations, and ensuring timely communication with physicians and patients.

The ideal candidate will have at least one year of related experience, knowledge of CPT/HCPCS/ICD-10 coding, and proficiency in Meditech and MS Excel, enabling efficient coordination with departments across the

Qualifications

• High school diploma or equivalent required.
• Experience with patient access, medical billing, or prior authorization preferred.
• Knowledge of CPT/HCPCS/ICD-10 coding is advantageous.

Responsibilities

• Verifies insurance eligibility and benefits with payer or payer website prior to starting the authorization process.
• Identifies payer policies for coverage and items requiring prior authorization.
• Ensures Medicare diagnosis support service and frequency guidelines are not exceeded when applicable.
• Manages daily work queues to submit prior authorizations timely and accurately.
• Notifies ordering physician’s office and patient about approval or denial of authorizations promptly.
• Follows up with payers to check status of previously submitted prior authorizations.
• Collaborates with the Director of Revenue Cycle to identify trends in denials and opportunities for improvement in the authorization process.
• Implements payer-specific checklists for eligibility, benefits, and authorization to cover pre-financial clearance.

Skills

Patient access

Medical billing

Prior authorization

Medical terminology

CPT/HCPCS/ICD-10 coding

Meditech

MS Excel

Team collaboration

Independent work

Adaptability

Education

High school diploma or equivalent

Tools

Meditech

MS Excel

Job description

Sullivan County Community Hospital is seeking a Prior Authorization Representative for a full-time clerical role in Sullivan, IN. The position involves confirming patient eligibility, processing prior authorizations, and ensuring timely communication with physicians and patients.

The ideal candidate will have at least one year of related experience, knowledge of CPT/HCPCS/ICD-10 coding, and proficiency in Meditech and MS Excel, enabling efficient coordination with departments across the