Prior Authorization Specialist | Oncology & Hematology Infusion | PRN Status

Logan Health; Kalispell, Northern (MT, KY); Hybrid; USD 39,000 - 65,000; Full time

Benefits offered by this job

401(k) match

Employee Assistance Program

Differential pay for certain shifts

Job summary

Logan Health is seeking an experienced Prior Authorization Specialist to obtain accurate authorizations for both facility and professional services. You will submit CPT/HCPCS codes and medical records to payers, verify demographics and patient data, and ensure all activities comply with HIPAA guidelines.

The role emphasizes attention to detail, timely processing, teamwork, and effective communication with clinics and leadership.

Qualifications

• Minimum of two (2) years’ experience in an acute care hospital, specialty clinic and/or medical billing office obtaining pre-certifications and/or prior-authorizations.
• Knowledge of commercial and government insurance requirements, medical terminology, and privacy regulations.
• Working knowledge of ICD-9 and CPT codes.
• Understanding of reimbursement and claims procedures and their impact on revenue cycle.
• Proficient computer skills including Microsoft Office; ability to learn new software.
• Excellent verbal and written communication; strong organizational and team skills.

Responsibilities

• Obtain accurate prior authorizations for facility and professional charges per department procedures.
• Submit CPT, HCPCS codes and medical records to insurers to expedite requests.
• Collect patient demographics and medical information; ensure HIPAA compliance.
• Review information for completeness; collaborate with stakeholders.
• Prioritize requests and confirm CPT/ICD-10 accuracy in orders.
• Maintain payer requirement resources and communicate with leadership on issues.
• Respond to denials with retro authorizations and appeals as needed.
• Document patient accounts of all actions taken.

Skills

Prior authorizations

Communication skills

HIPAA compliance

ICD-9 & CPT coding

Microsoft Office

Meditech experience

Tools

Meditech

Job description

This position is responsible for obtaining prior authorizations for all procedural orders by successfully completing the prior authorization process per department procedure and protocol.

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.

Qualifications:

• Minimum of two (2) years’ experience in an acute care hospital, specialty clinic and/or medical billing office obtaining pre-certifications and/or prior-authorizations required.
• Possess knowledge and understanding of commercial and government insurance requirements, medical terminology, and rules and regulations governing the handling of private health information required.
• Possess a working knowledge and understanding of ICD-9 and CPT codes required.
• Possess insight and understanding into reimbursement and claims procedures and its direct impact on the revenue cycle required.
• Possess and maintain computer skills to include working knowledge of Microsoft Office Suite and ability to learn other software as needed.
• Meditech experience preferred.
• Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.
• Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.
• Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.

Job Specific Duties:

• Responsible for obtaining accurate prior authorizations for facility and professional charges related to scheduled patient appointments per department procedure and protocol.
• Performs timely and accurate submission of CPT, HCPCS codes and medical records to insurance carriers to expedite prior authorization requests.
• Accurately secures patients’ demographics and medical information and ensures all procedures are in line with HIPPA compliance and regulations.
• Reviews accuracy and completeness of information requested and ensures all supporting documents are present.
• Collaborates with stakeholders as appropriate.
• Prioritizes incoming authorization requests according to department procedure and protocol.
• Confirms accuracy of CPT and ICD 10 diagnoses in the procedure order.
• Maintains the Logan Health intranet related to payer requirements needed to successfully obtain a prior authorization.
• Contacts patient and/or clinic to advise if authorization request has not been obtained prior to date of service.
• Researches and works with appropriate stakeholders in initiating retro authorization requests and resolving authorization denials as needed.
• Prepares, submits, and tracks appeals as necessary.
• Accurately documents patient accounts of all actions taken.
• Informs, educates, and communicates with leadership to include, but may not be limited to; billing or authorization concerns, backlogs, insurance issues, problematic accounts, documentation issues, etc.
• Adapts to changing circumstances to meet the needs of patient flow.
• Exhibits written and verbal professionalism at all times when interacting with others.
• Ensures all departmental transactions and interactions are completed with integrity, confidentiality, and professionalism.
• The above essential functions are representative of major duties of positions in this job classification.
• Specific duties and responsibilities may vary based upon departmental needs.
• Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job.
• Not all of the duties may be assigned to a position.

Maintains regular and consistent attendance as scheduled by department leadership.

Shift:

Day Shift - 8 Hours (United States of America)

Schedule:

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 Benefits:

• 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 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.

At Logan Health, our work is driven by our mission, vision, and values:

Our Mission Quality, compassionate care for all. Our Vision Reimagine health care through connection, service, and innovation. Our Core Values Be Kind – We foster compassion and positivity in our work environment. Work Together – Collaboration leads to innovation, efficiency, and improved communication. Trust and Be Trusted – We build trust by acting with authenticity, empathy, and good intent. Strive for Excellence – We continually push ourselves to improve, innovate, and deliver high-quality care and services.