Prior Authorization Specialist | Oncology & Hematology Infusion | PRN

Logan Health; United States; On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

401(k) plan

Employee Assistance Program

PRN / Casual scheduling

Job summary

Logan Health in Montana is seeking a detail-oriented Prior Authorization Specialist to ensure smooth pre-certifications for procedural orders within the Oncology & Hematology team. You will obtain authorizations, verify codes, and coordinate with insurers and care teams to support timely patient care.

The role requires 2+ years in hospital or specialty clinic settings, familiarity with ICD-9/CPT codes, and strong HIPAA compliance.

Qualifications

• 2+ years in hospital/clinic focusing on pre-certifications or authorizations.
• Knowledge of commercial and government insurance requirements and ICD-9/CPT codes.
• Strong HIPAA knowledge and proficiency in MS Office.

Responsibilities

• Obtain prior authorizations for facility and professional charges per protocols.
• Submit CPT and HCPCS codes and medical records to insurers to expedite authorizations.
• Verify patient demographics and medical details, ensuring HIPAA compliance.
• Review supporting documents and collaborate with stakeholders.
• Prioritize authorization requests and ensure CPT/ICD-10 code accuracy.
• Maintain intranet resources related to payer requirements for prior authorizations.
• Notify patients or clinics if authorization is not secured before service dates.
• Handle retro authorizations, resolve denials, and manage appeals as needed.
• Track all actions and update patient accounts accurately.
• Communicate issues like billing concerns to leadership.
• Adapt to changing circumstances to support patient flow.
• Maintain professionalism, integrity, and confidentiality.

Skills

Prior Authorization

Medical Billing

HIPAA Compliance

ICD-9/CPT codes

Microsoft Office

Meditech

Education

Associate or Bachelor’s degree

Tools

Microsoft Office

Meditech

Job description

At Logan Health, we’re more than just healthcare providers – we’re a community. Located in the heart of Montana, we deliver exceptional care to patients while creating a supportive and collaborative work environment for our team. Join us to grow professionally, enjoy comprehensive benefits, and make a meaningful impact in a place you’ll be proud to call home. Are you passionate about helping patients navigate the financial side of healthcare? We’re looking for a detail-oriented Prior Authorization Specialist to ensure a smooth and efficient process for obtaining prior authorizations for procedural orders.

Our Mission: Quality, compassionate care for all. Our Vision: Reimagine health care through connection, service and innovation. Our Core Values: Be Kind | Trust and Be Trusted | Work Together | Strive for Excellence.

Join Our Oncology & Hematology Prior Authorization Team at Logan Health!

Key Responsibilities:

• Obtain prior authorizations for facility and professional charges following departmental protocols.
• Submit CPT and HCPCS codes and medical records to insurers to expedite authorizations.
• Verify patient demographics and medical details, ensuring HIPAA compliance.
• Review and confirm all supporting documents and collaborate with necessary stakeholders.
• Prioritize authorization requests and ensure the accuracy of CPT and ICD-10 codes.
• Maintain intranet resources related to payer requirements for prior authorizations.
• Notify patients or clinics if authorization is not secured before service dates.
• Handle retro authorizations, resolve denials, and manage appeals as needed.
• Track all actions and update patient accounts accurately.
• Communicate issues like billing concerns, backlogs, and documentation needs to leadership.
• Adapt to changing circumstances to support patient flow.
• Maintain professionalism, integrity, and confidentiality in all interactions.

Basic Qualifications:

• 2+ years of experience in a hospital, specialty clinic, or medical billing setting focused on pre-certifications or prior authorizations.
• Knowledge of commercial and government insurance requirements, ICD-9/CPT codes, medical terminology, and HIPAA regulations.
• Familiarity with Microsoft Office and willingness to learn new software.
• Strong English communication skills, both written and verbal.

Preferred Qualifications:

• Associate or Bachelor’s degree.
• Experience with Meditech.
• Knowledge of managed care coverage, medical coding, and reimbursement procedures.
• Strong organizational skills, attention to detail, and task prioritization.
• Ability to work independently and as part of a team.
• Excellent interpersonal skills to handle confidential information professionally.
• Maintains regular and consistent attendance as scheduled by department leadership.

Shift: Day Shift - 8 Hours (United States of America) Schedule: PRN - 8 hour shifts, M-F as needed. Logan Health operates 24 hours per day, seven days per week. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. PRN positions (also referred to as Casual, As Needed, or Per Diem) at Logan Health offer flexibility and are designed to provide coverage during busy periods, employee absences, and vacations, making them an excellent opportunity to support the team as needed. PRN employees can participate in a matching 401(k) plan and have access to the Employee Assistance Program. Additionally, they may qualify for hourly differential pay for certain shifts or hours, offering extra compensation based on department-specific scheduling needs. Pay rates and scheduling practices may vary by department.

Notice of Pre-Employment Screening Requirements If you receive a job offer, please note all offers are contingent upon passing a pre-employment screening, which includes: Criminal background check Reference checks Drug Screening Health and Immunizations Screening Physical Demand Review/Screening Equal Opportunity Employer Logan Health is an Equal Opportunity Employer (EOE/AA/M-F/Vet/Disability). We encourage all qualified individuals to apply for employment. We do not discriminate against any applicant or employee based on protected veteran status, race, color, gender, sexual orientation, religion, national origin, age, disability or any other basis protected by applicable law. If you require accommodation to complete the application, testing or interview process, please notify Human Resources.

Welcome to One Sky Health and thank you for your interest in becoming a part of our team. We believe that everyone who works at One Sky Health is a caregiver, regardless of their position. We provide competitive pay and a comprehensive benefits package. Our employees are motivated by our commitment to provide quality patient care for our community. Our people are everything. The amazing providers, employees, and volunteers at One Sky Health gift this organization with their innovation, knowledge, and compassion. Together, we're connecting our community to trusted, quality care and helping to improve lives every day.

Do you dream of living and working in a beautiful area surrounded by stunning scenery and endless recreation? Are you ready to evolve your career while working alongside passionate, talented, brilliant people? Join our remarkable team and create positive patient experiences every day!