Prior Authorization Specialist: Streamline Healthcare Approvals

Mt. Graham Regional Medical Center; Arizona; On-site; USD 40,000 - 60,000; Full time

Job summary

Mt. Graham Regional Medical Center seeks a dedicated Prior Authorization Specialist to secure timely authorizations for services and ensure compliant reimbursement. You will review clinical data, liaise with payers, and document approvals in the EHR and billing systems to prevent denials.

The role requires strong communication, organization, and attention to detail, with a focus on accurate documentation and patient service.

Qualifications

• Must be at least 18 years of age.
• Education level: high school diploma or equivalent; associate/bachelor’s preferred.
• Build rapport with patients and provide excellent interpersonal communication.
• Organized and detail oriented; able to take direction.
• Understand insurance payors and detailed contracts; verify coverage.
• Review procedures to determine prior authorization necessity.
• Clear, proactive communication with providers, team members, and patients.
• Accurate documentation of authorization numbers and processes.

Responsibilities

• Secure timely insurance authorizations for scheduled and unscheduled services.
• Review clinical and insurance information; communicate with payers and internal stakeholders.
• Document authorization approvals accurately in the EHR and billing systems.
• Prevent authorization-related denials by thorough review and follow-up.
• Verify insurance coverage and eligibility; record details in systems.
• Collect co-pays and deductibles; ensure patient service satisfaction.

Skills

Rapport with patients

Interpersonal skills

Organized

Detail oriented

Follow directions

Written communication

Communication with payers

Documentation accuracy

Education

High school diploma or equivalent

Associate or bachelor's degree preferred

Tools

EHR systems

Billing software

Insurance payor contracts

Job description

Mt. Graham Regional Medical Center seeks a dedicated Prior Authorization Specialist to secure timely authorizations for services and ensure compliant reimbursement. You will review clinical data, liaise with payers, and document approvals in the EHR and billing systems to prevent denials.

The role requires strong communication, organization, and attention to detail, with a focus on accurate documentation and patient service.