Prior Authorization Specialist

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🔥 3 minutes ago

🌵 Arizona, Colorado, +16 more states – Remote

🌵 Arizona – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌪️ Kansas – Remote 🦬 Montana – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌲 Oregon – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote ☕ Washington – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

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Logan Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Logan Health is a healthcare system founded in 1910 that has been dedicated to providing exceptional care for over a century. Its main medical campus is located in Flathead County, serving a total service area that spans 13 counties, covering nearly 40,000 square miles and a population of more than 600,000. The system includes six hospitals, more than 50 provider clinics, and a variety of other healthcare services, notably including the nation's first rural air ambulance service (A. L. E. R. T. ).

📋 Description

• Obtain prior authorizations for facility and professional charges following departmental protocols. • Submit CPT and HCPCS codes and medical records to insurers to expedite authorizations. • Verify patient demographics and medical details, ensuring HIPAA compliance. • Review and confirm all supporting documents and collaborate with necessary stakeholders. • Prioritize authorization requests and ensure the accuracy of CPT and ICD-10 codes. • Maintain intranet resources related to payer requirements for prior authorizations. • Notify patients or clinics if authorization is not secured before service dates. • Handle retro authorizations, resolve denials, and manage appeals as needed. • Track all actions and update patient accounts accurately. • Communicate issues like billing concerns, backlogs, and documentation needs to leadership. • Adapt to changing circumstances to support patient flow. • Maintain professionalism, integrity, and confidentiality in all interactions.

🎯 Requirements

• 2+ years of experience in a hospital, specialty clinic, or medical billing setting focused on pre-certifications or prior authorizations. • Knowledge of commercial and government insurance requirements, ICD-9/CPT codes, medical terminology, and HIPAA regulations. • Familiarity with Microsoft Office and willingness to learn new software. • Strong English communication skills, both written and verbal. • Associate or Bachelor’s degree preferred. • Experience with Meditech preferred. • Knowledge of managed care coverage, medical coding, and reimbursement procedures preferred. • Strong organizational skills, attention to detail, and task prioritization. • Ability to work independently and as part of a team. • Excellent interpersonal skills to handle confidential information professionally.

🏖️ Benefits

• Opportunities for growth • Comprehensive benefits