Revenue Cycle Pre-Authorization Specialist 8-430

Centra Health, Inc.; Lynchburg (VA); Presencial; USD 25.000 - 30.000; Jornada completa

Descripción de la vacante

Centra Health, Inc. is seeking an experienced Prior Authorization Specialist to obtain authorizations for surgeries, imaging and other scheduled services across Centra Health locations.

You will verify patient demographics, insurance details, and update the EMR to ensure timely approvals. In this role you will liaise with providers, hospitals, and insurance plans, monitor payer timelines, and communicate any delays to scheduling teams.

Formación

• High school diploma or equivalent.
• Proficient with Microsoft Office Products.
• Proficient typing and spelling.
• Proficient computer skills and multitasking across applications.
• Strong customer service, detail orientation, and communication skills.
• Ability to work independently and stay productive.

Responsabilidades

• Obtain prior authorizations for surgeries, imaging, and scheduled services.
• Verify insurance eligibility and update EMR as needed.
• Initiate timely authorization requests via phone or payer portal.
• Submit medical documentation required for authorizations.
• Obtain additional information from providers as appropriate.
• Communicate delays or rescheduling needs due to payer issues.
• Adhere to HIPAA, CMS, EMTALA, and other regulations.

Conocimientos

Customer service

Attention to detail

Communication skills

Multitasking

Typing

Microsoft Office

Educación

High school diploma

Some college experience

Associates degree

Bachelor's degree

Herramientas

Microsoft Office

Descripción del empleo

Job Description

This position is responsible for obtaining prior authorizations for all scheduled/ordered services for hospital locations including Centra Central Virginia Imaging. Essential duties include obtaining prior authorizations and ensuring accurate demographic and insurance information is entered into applicable systems for scheduled services. Acts as a liaison for providers requesting hospital services at Centra Health requiring a prior authorization.

Responsibilities

• Communicates with insurance companies to obtain prior authorizations for surgeries, imaging studies, cardiology testing, surgical procedures, Interventional testing/procedures and other scheduled services
• Verifies insurance eligibility and benefit information and updates EMR as appropriate
• Initiates timely prior authorization requests with insurance plans either by phone or the payer portal
• Submits medical documentation needed to obtain prior authorizations
• Requests medical records, updated orders, and insurance information from non-CMG providers when appropriate.
• Requests additional information as appropriate from CMG providers.
• Monitors all worklists for urgent scheduling add-ons to secure prior authorizations
• Coordinates peer-to-peer requests with insurance plans and the ordering providers
• Demonstrates persistence when obtaining authorization status from insurance carriers
• Updates the patient accounting system with authorization numbers for specified services and date spans
• Notifies Scheduling/Registration and ordering providers of any delays or rescheduling needs due to payer delays
• Understands payer policies related to authorization requirements and timeframes needed to obtain authorizations
• Appropriately respond to phone calls, emails, Teams messages, and other forms of communication.
• Complies with governmental regulations in reference to healthcare, billing, the Health Insurance Portability and Accountability Act (HIPAA), The Joint Commission (TJC) standards, Centers for Medicare and Medicaid Services (CMS), Emergency Medical Treatment and Labor Act (EMTALA), as well as Centra and Acute Revenue Cycle department policies and procedures.

Other Functions

Provides courteous service to all stakeholders (patients, patient families, teammates, other department staff, etc.) by resolving stakeholder problems, responding to inquiries, and following up to develop and strengthen customer relationships.

Cover other shifts and departments as needed within Acute Revenue Cycle Departments.

Assist in training of new hires as needed.

Perform other duties as assigned or requested and job specifications can be modified or updated at any time.

Qualifications

Required Qualifications:

• High school diploma or equivalent
• Proficient with Microsoft Office Products
• Proficient typing and spelling
• Proficient computer skills, multitasking with data entry while using multiple computer applications
• Ability to provide high level of customer service, attention to detail, critical thinking, and have proficient written and verbal communication skills
• Ability to work independently and maintain productivity.

Preferred Qualifications:

• Some college experience in healthcare, business, accounting and/or professional certification preferred. Associates degree and/or bachelor’s degree in medical preferred
• Prior Revenue Cycle experience in a healthcare setting
• Prior authorization experience in a healthcare setting
• Knowledge of ICD-10 and CPT codes as well as other medical terminology
• Knowledge of insurance plans
• Have an understanding and ability to communicate financial and insurance information