Prior Authorization Specialist - Oncology Infusion

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

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.