Prior Authorization Specialist - Onsite*

Cherrycountyhospital; Northern (KY); Hybrid; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

Retirement Plan

Job summary

Cherry County Hospital is hiring a Prior Authorization Specialist to obtain pre-certifications for procedures and medications. You will verify patient eligibility, coordinate with carriers, and secure timely authorizations for services.

Role requires high school diploma, preferred medical setting experience, and proficiency with Excel, Word, and Windows. You will work onsite in a collaborative hospital and clinic environment with comprehensive benefits.

Qualifications

• High school diploma required or equivalent.
• Prior customer service experience in medical settings preferred.
• Knowledge of medical terminology preferred.
• Experience with Excel, Word and Windows highly desirable.

Responsibilities

• Obtain pre-certifications and pre-authorizations for procedures and medications.
• Contact insurance carriers to verify patient eligibility and benefits.
• Track and obtain authorizations and follow up to ensure timely approvals.
• Document communications in standardized format and maintain confidentiality.
• Assist with scheduling and record retrieval as needed.
• Communicate insurance updates to departments as needed.

Skills

Communication skills

Microsoft Excel

HIPAA knowledge

Medical terminology

Data interpretation

Team collaboration

Confidentiality

Education

High school diploma

Tools

Microsoft Excel

Microsoft Word

Windows

Job description

Description

Location: Cherry County Hospital, Valentine, NE
Position: Full-Time (40 hours/week) – Onsite
Compensation: Competitive wage based on experience
Benefits: Eligible for benefits

Now Hiring – Prior Authorization Specialist: About the Position

Cherry County Hospital is seeking a dedicated and detail-oriented Prior Authorization Specialist to join our team. In this important role, you will be responsible for obtaining pre-certifications and pre-authorizations for medical procedures and medications at our hospital and clinic.

Duties and Responsibilities

As a Prior Authorization Specialist, you will:

• Contact insurance carriers to verify patient eligibility, benefits, and requirements.
• Request, track, and obtain pre-authorizations for medical procedures and services.
• Follow up with insurance carriers to ensure timely authorizations before services are performed.
• Demonstrate knowledge of medical terminology, office procedures, and HIPAA regulations.
• Communicate insurance changes or trends to appropriate departments.
• Maintain a level of productivity appropriate for the department.
• Appeal insurance/payor denials when applicable.
• Document all communications and contacts in a standardized format.
• Notify department heads of additional staffing or equipment needs.
• Assist with filing and record retrieval as needed.
• Work cooperatively and effectively with staff, physicians, and the public.
• Maintain strict confidentiality of patient medical, personal, and financial information.
• Follow corporate compliance policies and procedures.
• Perform additional duties as assigned by the supervisor.

Skills and Abilities

• Excellent verbal and written communication skills.
• Proficiency with computers and Microsoft Excel, Word, and Windows.
• Strong organizational skills and ability to interpret data.
• Strong judgment, tact, diplomacy, and problem-solving skills.
• Ability to work collaboratively in a team environment.
• Strong attention to confidentiality of hospital and patient information.
• Ability to perform repetitive tasks with minimal independent judgment.
• Familiarity with state and federal confidentiality laws, including HIPAA, and the ability to follow policies regarding the privacy and security of health information.

Physical Demands and Working Conditions

• Sedentary work involving periods of sitting, talking, typing, and listening.
• Repetitive use of hands, arms, and eyes, which may cause strain.
• Significant manual dexterity required to operate business office machines and equipment.

Job Requirements

• High school diploma required.
• Prior customer service experience in a medical setting preferred.
• Knowledge of medical terminology preferred.
• Previous experience with Microsoft Excel, Word, and Windows.

Comprehensive Benefit Package

• Health Insurance: Co-pay or HSA plan options; 100% paid for employee.
• Dental Insurance: 100% paid for employee.
• Vision Insurance: 100% paid for employee.
• Group Life Insurance: $50,000 with AD&D.
• Long-Term Disability: 100% paid for employee.
• Flexible Spending Accounts: Medical and dependent care options.
• Health Savings Account: Includes employer contribution.
• Supplemental Insurance: Short-Term Disability, Supplemental Life and AD&D, Critical Illness, Hospital Indemnity, and Accident.
• Retirement Plan: 457 plan with Pre-Tax and Roth options.

Why Cherry County Hospital?

• Be part of a dedicated and compassionate healthcare team.
• Enjoy competitive pay and excellent benefits.
• Work in a collaborative and supportive environment.
• Make a meaningful contribution to healthcare in our community.