Prior Authorization Specialist - Healthcare Revenue Cycle

Med Center Health; Bowling Green (KY); On-site; USD 36,000 - 60,000; Full time

Job summary

Med Center Health is seeking an Authorization Specialist to obtain prior authorizations, precertifications, and other payer-required approvals for scheduled services. You will serve as a liaison among providers, clinical staff, scheduling teams, patients, and payers to gather information, submit requests, and communicate status to minimize delays in care.

The role requires knowledge of payer requirements and strong organizational skills to ensure accurate documentation and timely processing in

Qualifications

• Experience in healthcare, insurance verification, prior authorization, patient access or revenue cycle preferred.
• High School Diploma or GED preferred.
• Knowledge of medical terminology, healthcare insurance plans, and payer authorization requirements preferred.
• Knowledge of prior authorization processes and reimbursement practices preferred.
• Strong verbal and written communication skills.
• Strong organizational skills and attention to detail.
• Ability to manage multiple priorities and meet deadlines.
• Ability to work effectively with patients, providers, clinical staff, and payer representatives.
• Proficiency with computer systems and standard office software applications.
• Experience with Epic or similar electronic health record systems preferred.

Responsibilities

• Reviews scheduled services and procedures to determine authorization, precertification, or other payer approval requirements.
• Obtains prior authorizations, precertifications, and other payer-required approvals for scheduled services and procedures.
• Verifies payer requirements, coverage guidelines, clinical documentation needs, and submission processes.
• Communicates with insurance carriers, provider offices, clinical departments, scheduling teams, and patients as needed to obtain information required for authorization requests.
• Submits authorization requests with accurate patient, provider, service, diagnosis, procedure, and supporting clinical information.
• Monitors authorization work queues and follows up on pending requests to support timely financial clearance.
• Tracks authorization status, payer determinations, approval numbers, effective dates, and related information in designated systems.
• Communicates authorization approvals, delays, denials, missing information, or other issues to appropriate stakeholders in a timely manner.
• Escalates complex authorization issues, payer delays, urgent requests, or potential barriers to the appropriate supervisor or department contact.
• Assists with authorization-related denials, payer inquiries, and requests for additional information.
• Maintains current knowledge of payer authorization requirements, medical necessity guidelines, coverage policies, and workflow changes.
• Ensures authorization processes are completed in accordance with payer requirements, regulatory standards, and organizational policies.
• Supports denial prevention efforts by ensuring authorization accuracy, timely follow-up, and complete documentation.
• Participates in process improvement activities to enhance authorization efficiency, accuracy, and service quality.

Skills

Healthcare experience

Insurance verification

Prior authorization

Strong communication

Organizational skills

Multi-tasking

Team collaboration

Epic EHR familiarity

Education

High School Diploma or GED

Tools

Epic or similar EHR

Job description

Med Center Health is seeking an Authorization Specialist to obtain prior authorizations, precertifications, and other payer-required approvals for scheduled services. You will serve as a liaison among providers, clinical staff, scheduling teams, patients, and payers to gather information, submit requests, and communicate status to minimize delays in care.

The role requires knowledge of payer requirements and strong organizational skills to ensure accurate documentation and timely processing in