VA/Tricare Authorization & Audit Specialist

St. Joseph’s/Candler Health System; Savannah (GA); Hybrid; USD 42,000 - 62,000; Full time

Job summary

St. Joseph’s/Candler Health System in Savannah, GA is seeking a VA Auth/Referral and Auditing Specialist to verify patient insurance coverage, obtain necessary prior authorizations, and review medical records to determine policy coverage, ensuring timely access to care while managing the financial aspects of treatment.

The role supports departments such as LCRP, Patient Accounts, Pre-Service and Registration, with emphasis on HIPAA compliance, accurate EMR documentation, and proactive denial

Qualifications

• High School Diploma preferred.
• 1-3 years Insurance experience required.
• 2-3 years Medical background preferred.

Responsibilities

• Maintains patient records in an organized and secure manner, ensuring HIPAA regulations are followed.
• Determines precertification necessity and coordinates with insurance companies to maximize reimbursement.
• Monitors reports for precertification needs and conducts initial and concurrent reviews until precertification is obtained.
• Documents precertification and payer correspondence in the EMR and ensures front desk staff collects referral information to limit denials.
• Records missing or incorrect authorizations and investigates delays in patient treatment.

Skills

HIPAA compliance

Attention to detail

Interdepartmental communication

Education

High School Diploma

Tools

EMR system

Job description

St. Joseph’s/Candler Health System in Savannah, GA is seeking a VA Auth/Referral and Auditing Specialist to verify patient insurance coverage, obtain necessary prior authorizations, and review medical records to determine policy coverage, ensuring timely access to care while managing the financial aspects of treatment.

The role supports departments such as LCRP, Patient Accounts, Pre-Service and Registration, with emphasis on HIPAA compliance, accurate EMR documentation, and proactive denial