Prior Authorization & Utilization Specialist

Priority Dispatch Corp.; Cozad (NE); On-site; USD 53,726,000 - 89,544,000; Full time

Job summary

Cozad Community Health System is hiring an entry-level Prior Authorization Specialist at Cozad Community Hospital in Cozad, NE. The role focuses on obtaining prior authorizations for outpatient and inpatient services and monitoring utilization review adherence.

The position requires a high school diploma or equivalent, EHR experience, medical terminology knowledge, and strong time-management skills to ensure timely patient care and compliance with HIPAA guidelines.

Qualifications

• High school diploma or equivalent required.
• Electronic Health Records experience, medical terminology knowledge, computer experience, and ability to examine documents for accuracy required.
• Excellent time management skills with a proven ability to meet deadlines required.

Responsibilities

• Responds to all correspondence from providers and patients regarding prior authorization.
• Submits authorization requests via insurance portals or phone calls; tracks pending requests to ensure timely services.
• Reviews demographic and insurance information in patient accounts and notifies the Business Office of corrections.
• Contacts provider staff when pre-certification is needed and confirms pre-certifications have been obtained.
• Researches and maintains current payor rules by using all resources.
• Establishes efficient methods to ensure medical necessity and appropriate admissions.
• Coordinates with Billing to resolve denials and support concurrent reviews for extended stays.

Skills

Electronic Health Records experience

Medical terminology knowledge

Time management

Communication with patients

Education

High school diploma or equivalent

CPR certification (Basic Life Support)

Tools

EHR systems

Job description

Cozad Community Health System is hiring an entry-level Prior Authorization Specialist at Cozad Community Hospital in Cozad, NE. The role focuses on obtaining prior authorizations for outpatient and inpatient services and monitoring utilization review adherence.

The position requires a high school diploma or equivalent, EHR experience, medical terminology knowledge, and strong time-management skills to ensure timely patient care and compliance with HIPAA guidelines.