Prior Authorization Specialist: Streamline Approvals

Weston County Health Services; Newcastle (WY); On-site; USD 45,000 - 60,000; Full time

Job summary

Weston County Health Services seeks a Pre/Prior Authorization Specialist to verify patient insurance eligibility, determine pre-certifications, and obtain required authorizations prior to services across the hospital, Manor, and clinics. You will ensure data accuracy and communicate with payers and patients to support financial clearance and a positive patient experience.

The role reports to the Chief Financial Officer and requires attention to detail, strong communication, and knowledge of

Qualifications

• Minimum high school diploma or equivalent.
• Two years' experience in a medical business office, insurance verification, authorization, or patient-facing customer service.
• Working knowledge of insurance eligibility, benefits, pre-certification, and prior authorization processes for Medicare, Medicaid, and commercial payers.
• Proficiency with electronic health record and patient registration/accounting systems.
• Excellent verbal and written communication skills.

Responsibilities

• Verifies patient insurance eligibility, coverage, and benefits prior to scheduled services.
• Determines pre-certification and prior authorization requirements for scheduled services.
• Obtains required authorizations and referrals from third-party payers before services are rendered.
• Ensures data elements for an authorization are complete and submitted with requests.
• Communicates authorization status to patients, insurers, and providers; escalates financial clearance risks as needed.
• Documents all authorization work clearly and maintains confidentiality.

Skills

Insurance verification

Pre-certifications

Prior authorizations

Payer communications

Data entry

Attention to detail

Education

High School Diploma

Medical terminology coursework

Health care business services program

Tools

Electronic health record systems

Patient registration software

Job description

Weston County Health Services seeks a Pre/Prior Authorization Specialist to verify patient insurance eligibility, determine pre-certifications, and obtain required authorizations prior to services across the hospital, Manor, and clinics. You will ensure data accuracy and communicate with payers and patients to support financial clearance and a positive patient experience.

The role reports to the Chief Financial Officer and requires attention to detail, strong communication, and knowledge of