Prior Authorization Specialist - Payer & Clinic Support

Riverview Health; Noblesville (IN); Hybrid; USD 38,000 - 52,000; Full time

Job summary

Riverview Health in Noblesville, IN is seeking an Authorization Specialist to manage payer authorizations for scheduled services and ensure alignment with payer contracts.

You will verify insurance benefits, obtain prior authorizations, gather demographic and clinical information, and update the EMR as needed.

The role requires HIPAA compliance, professional communication with patients and payers, and collaboration with departments to resolve authorization issues.

Qualifications

• Minimum: Associate degree in healthcare or business administration and/or related coursework, or comparable experience.
• Preferred: Epic experience.

Responsibilities

• Verifies patients’ insurance and benefits information.
• Obtains prior authorizations from third-party payers according to requirements.
• Gathers demographic and insurance information from patients and updates EMR.
• Gathers clinical information from departments to support authorization.
• Develops price estimates for patient out-of-pocket responsibility.
• Refer accounts to financial counseling when authorization is not obtained.
• Supports appeal efforts for authorization-related denials.
• Reviews schedules to ensure Medicare IP-only procedures have the proper authorization.
• Complies with HIPAA regulations and Riverview Health policies.
• Mantains a professional tone when communicating with patients and payers.
• Coordinates re-education to practices/departments when orders are incorrect.
• Performs other duties as requested.

Skills

Insurance verification

Prior authorizations

EMR data entry

Patient communication

Denials appeal support

HIPAA compliance

Interdepartmental coordination

Education

Associates degree in healthcare or business administration

Tools

Epic

Job description

Riverview Health in Noblesville, IN is seeking an Authorization Specialist to manage payer authorizations for scheduled services and ensure alignment with payer contracts.

You will verify insurance benefits, obtain prior authorizations, gather demographic and clinical information, and update the EMR as needed.

The role requires HIPAA compliance, professional communication with patients and payers, and collaboration with departments to resolve authorization issues.