Prior Authorization Specialist — Revenue Cycle

Sullivan County Community Hospital; New York, Northern (NY, KY); Hybride; USD 36 000 - 54 000; Plein temps

Résumé du poste

Sullivan County Community Hospital is seeking a Prior Authorization Representative to join our well‑established Revenue Cycle team in Sullivan, IN. The role focuses on verifying insurance, documenting payer policies, and ensuring prior authorizations are processed quickly and accurately.

You will work with physicians, HIM, IT, and patient financial services to resolve denials and improve authorization workflows. Strong attention to time constraints and minimal supervision are essential.

Qualifications

• High school diploma or equivalent required.
• 1 year of patient access, medical billing, or prior authorization experience preferred.
• Knowledge of medical terminology and CPT/HCPCS/ICD-10 coding.
• Proficiency with Meditech and MS Excel expected.

Responsabilités

• Verify insurance eligibility and benefits with payer or payer website before authorization.
• Document payer policies and procedures for coverage and required prior approvals.
• Ensure Medicare diagnosis support service and frequency guidelines are followed when applicable.
• Manage daily work queues to submit prior authorizations timely and accurately.
• Notify ordering physician’s office and patient of authorization status (approval/denial).
• Follow up with payers on status of prior authorizations.
• Identify denial trends and opportunities for process improvement with Revenue Cycle leadership.
• Implement payer-specific checklists for eligibility, benefits, and authorization.

Connaissances

Patient access

Medical terminology

Coding knowledge (CPT/HCPCS/ICD-10)

Meditech

MS Excel

Collaboration

Time management

Adaptability

Formation

High school diploma or equivalent

Outils

Meditech

MS Excel

Description du poste

Sullivan County Community Hospital is seeking a Prior Authorization Representative to join our well‑established Revenue Cycle team in Sullivan, IN. The role focuses on verifying insurance, documenting payer policies, and ensuring prior authorizations are processed quickly and accurately.

You will work with physicians, HIM, IT, and patient financial services to resolve denials and improve authorization workflows. Strong attention to time constraints and minimal supervision are essential.