Prior Authorization Tech

Republic County Hospital; Belleville (KS); On-site; USD 38,000 - 48,000; Full time

Job summary

Republic County Hospital in Belleville, KS is seeking a Prior Authorization Tech in the HIM department to review service requests, ensure they meet payer rules and clinical criteria, and facilitate approvals while documenting interactions with providers, patients, and insurers.

The PA Tech will log requests, review records, gather documentation, contact providers or patients for missing info, perform data entry, verify eligibility, and support quality initiatives and care coordination.

Qualifications

• Excellent written and verbal communication skills.
• Strong critical thinking and problem-solving abilities.
• Strong organizational, planning, time management and prioritizing skills.
• Proficiency in MS Office and patient management software/databases.
• Understanding of medical terminology and coding is beneficial.

Responsibilities

• Receive, process, and log authorization requests for services, medications, or procedures.
• Review patient records and gather necessary documentation.
• Contact providers, pharmacies, or patients for missing clinical documentation or clarification.
• Handle phone calls with insurance providers and perform data entry.
• Coordinate with providers, administrators, and patients via phone, fax, or portals.
• Verify patient eligibility and benefits; track pending requests and follow up for timely approval.
• Assist with quality projects and other duties as assigned.

Skills

Communication skills

Critical thinking

Organizational skills

Data entry

Insurance coordination

Education

High School Diploma

Associate's Degree or billing/coding certification

CPC/CCA/CMAA certifications preferred

Job description

JOB DESCRIPTION

JOB TITLE: Prior Authorization Tech

DEPARTMENT: HIM (Health Information Management)

JOB RELATIONSHIPS:

Reports:

Responsible To: HIM Manager

Responsible For: Does not supervise other employees

Interrelationships: Works cooperatively with all clinic and hospital departments, medical staff, patients and visitors.

JOB SUMMARY:

The Prior Authorization (PA) Tech works under the supervision of the HIM Manager. The PA Tech reviews requests for medical services, medications, or procedures, ensuring they meet clinical criteria, payer rules, and regulations before approval, acting as a crucial link between providers, patients, and insurers to facilitate necessary care while managing costs and documentation, often involving phone calls, record review, and data entry in health systems.

JOB QUALIFICATIONS:

Experience:

• Previous experience in a healthcare setting is preferred.

Education:

Prior-Authorization Tech

• High School Diploma or equivalent
• Associate's Degree or certified in medical billing, coding, or healthcare administration, preferred.
• Certifications preferred in the following areas: CPC, CCA, CMAA.

KEY COMPETENCIES:

• Excellent written and verbal communication skills
• Strong critical thinking and problem-solving.
• Strong organizational, planning, time management and prioritizing skills
• Proficiency in MS Office and patient management software and databases.
• Understanding of medical terminology and coding. (beneficial)
• (PA) Tech role requires administrative skills with attention to detail, data entry, and insurance verification and coordination.
• This list is not exhaustive and may be supplemented as necessary.

JOB RESPONSIBILITIES:

• Receive, process, and log authorization requests for services, medications, or procedures.
• Review patient records.
• Gather necessary documentation and process requests. Contact providers, pharmacies or patients for missing clinical documentation or clarification.
• Handles phone calls with insurance providers.
• Data entry, accurately update patient and authorization data in medical management systems.
• Coordinate with providers, administrators and sometimes patients via phone, fax or electronic portals.
• Track pending requests and follow up to ensure timely approval.
• Assist with HCAHPS, Quality projects, and other duties as assigned.
• Verify patient eligibility and benefits.
• Act as a liaison between providers, patients, and the clinical team.
• Assist in assembling and submitting necessary paperwork.
• This list is not exhaustive and may be supplemented as necessary.

WORKING CONDITIONS:

• Occasionally exposed to the risk of blood borne diseases.
• Contact with patients under a wide variety of circumstances.
• Occasionally exposed to unpleasant elements (accidents, injuries and illness)
• Subject to varying and unpredictable situations.

ESSENTIAL FUNCTIONS:

• Light to Medium physical effort (lift/carry up to 50 lbs.)
• Occasional standing/walking
• Occasionally lifts supplies/equipment
• Eye-hand coordination
• This list is not exhaustive and may be supplemented as necessary.

PHYSICAL REQUIREMENTS:

• Level 3 (Available upon request)