Prior Authorization Specialist I — Hospital Admissions

Community Hospital, CO; Grand Junction (CO); On-site; USD 26,000 - 30,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life Insurance

Free Parking

Paid time off

Education assistance

403(b) matching

Job summary

Community Hospital in Grand Junction, CO, is seeking a Prior Authorization specialist to support the Hospital Admissions team. The role involves gathering patient information, verifying insurance coverage, and submitting pre-authorization requests to insurers.

You will follow up on pending requests, communicate with healthcare providers, educate patients about the process, and maintain detailed records to ensure HIPAA-compliant workflows.

Qualifications

• High school diploma or equivalent.
• Knowledge of medical terminology preferred.

Responsibilities

• Gather Patient Information: Collect and review patient medical records, diagnosis codes, and procedure details to support the pre-authorization request.
• Verify Insurance Coverage: Confirm patient information and insurance coverage through verifying photo ID, insurance cards, and personal information.
• Submit Pre-Authorization Requests: Prepare and submit pre-authorization requests to insurance companies, adhering to their specific procedures and requirements.
• Follow Up: Monitor the progress of pre-authorization requests and follow up with insurance providers to expedite the approval process.
• Communicate with Healthcare Providers: Collaborate with healthcare providers to obtain any necessary documentation, notes, or additional information required for pre-authorization.
• Patient Education: Explain the pre-authorization process to patients, including potential out-of-pocket costs, and address any questions or concerns they may have.
• Document and Recordkeeping: Maintain detailed records of pre-authorization requests, approvals, denials, and communications with insurance companies and healthcare providers.
• Compliance: Ensure that all pre-authorization processes comply with relevant laws and regulations, including HIPAA (Health Insurance Portability and Accountability Act).

Skills

Medical terminology

Education

High school diploma or equivalent

Job description

Community Hospital in Grand Junction, CO, is seeking a Prior Authorization specialist to support the Hospital Admissions team. The role involves gathering patient information, verifying insurance coverage, and submitting pre-authorization requests to insurers.

You will follow up on pending requests, communicate with healthcare providers, educate patients about the process, and maintain detailed records to ensure HIPAA-compliant workflows.