Prior Authorization Specialist – Patient Care Access

Regional West Medical Services; Scottsbluff (NE); On-site; USD 45,000 - 58,000; Full time

Benefits offered by this job

Tuition reimbursement

Professional development

Competitive benefits

Job summary

Regional West Medical Center is seeking an Authorization Specialist to support timely and accurate prior authorization for patient services. The role requires obtaining authorizations for surgeries, imaging, procedures, medications, VA services, DME, and referrals while ensuring payer requirements are met.

The ideal candidate has 2+ years of healthcare experience, knowledge of insurance processes, and strong attention to detail.

Qualifications

• Two or more years of healthcare experience preferred.
• Knowledge of insurance processes and medical terminology preferred.
• Strong attention to detail and accuracy.
• Ability to multitask and prioritize in a fast-paced environment.
• Basic computer skills and comfort with electronic health records.
• Excellent customer service, communication, and problem-solving skills.
• Commitment to compliance, confidentiality, and patient-centered care.

Responsibilities

• Obtain prior authorizations for surgeries, diagnostic imaging, procedures, medications, VA services, DME, and referrals.
• Receive and process orders via the electronic health record or fax according to priority status.
• Verify patient insurance eligibility and benefits.
• Initiate authorizations through payer portals, phone, or fax, providing required clinical documentation.
• Document authorizations, approvals, denials, appeals, and communications in the electronic health record per protocol.
• Follow Prior Authorization policies, workflows, and quality metrics.
• Identify and resolve authorization discrepancies promptly.
• Coordinate with providers, clinical staff, and internal teams to ensure services align with approved authorizations.
• Maintain confidentiality and comply with HIPAA and organizational policies.
• Adapt to changing workflows and departmental needs.

Skills

Healthcare experience

Insurance processes

Attention to detail

Multitasking

EHR proficiency

Customer service

HIPAA compliance

Education

High school diploma

Job description

Regional West Medical Center is seeking an Authorization Specialist to support timely and accurate prior authorization for patient services. The role requires obtaining authorizations for surgeries, imaging, procedures, medications, VA services, DME, and referrals while ensuring payer requirements are met.

The ideal candidate has 2+ years of healthcare experience, knowledge of insurance processes, and strong attention to detail.