Prior Authorization Specialist — Patient Care & Compliance

Regional West; Scottsbluff (NE); On-site; USD 38,000 - 52,000; Full time

Job summary

Regional West Medical Center in Scottsbluff, NE is seeking an Authorization Specialist to support timely and accurate prior authorization for patient services. This role ensures authorizations are obtained for surgeries, imaging, procedures, medications, VA services, DME, and referrals, and properly documented in the EHR.

You'll collaborate with providers and staff to verify benefits, follow payer requirements, and maintain confidentiality while adapting to changing workflows.

Qualifications

• High school diploma or equivalent required.
• 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 knowledge

Medical terminology

Attention to detail

Multitasking

Basic computer skills

Customer service

Communication skills

Confidentiality

HIPAA compliance

Education

High school diploma

Job description

Regional West Medical Center in Scottsbluff, NE is seeking an Authorization Specialist to support timely and accurate prior authorization for patient services. This role ensures authorizations are obtained for surgeries, imaging, procedures, medications, VA services, DME, and referrals, and properly documented in the EHR.

You'll collaborate with providers and staff to verify benefits, follow payer requirements, and maintain confidentiality while adapting to changing workflows.