Prior Authorization Specialist

locations:
Remote Location
*
* Location:

** Remote (see approved states list)  
*
* Schedule:

** Day Shift – 8 Hours | Full-Time – 40 Hours
* 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.
* 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.
* Experience with Meditech.
* Knowledge of managed care coverage, medical coding, and reimbursement procedures.
* 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.
* Minimum of two (2) years’ experience in an acute care hospital, specialty clinic and/or medical billing office obtaining pre-certifications and/or prior-authorizations required.
* Possess knowledge and understanding of commercial and government insurance requirements, medical terminology, and rules and regulations governing the handling of private health information required.
* Possess a working knowledge and understanding of ICD-9 and CPT codes required.
* Possess insight and understanding into reimbursement and claims procedures and its direct impact on the revenue cycle required.
* Possess and maintain computer skills to include working knowledge of Microsoft Office Suite and ability to learn other software as needed. Meditech experience preferred.
* Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.
* Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.
* Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.
* Responsible for obtaining accurate prior authorizations for facility and professional charges related to scheduled patient appointments per department procedure and protocol.
* Performs timely and accurate submission of CPT, HCPCS codes and medical records to insurance carriers to expedite prior authorization requests.
* Accurately secures patients’ demographics and medical information and ensures all procedures are in line with HIPPA compliance and regulations.
* Reviews accuracy and completeness of information requested and ensures all supporting documents are present.  Collaborates with stakeholders as appropriate.
* Prioritizes incoming authorization requests according to department procedure and protocol.  Confirms accuracy of CPT and ICD 10 diagnoses in the procedure order.
* Maintains the Logan Health intranet related to payer requirements needed to successfully obtain a prior authorization.
* Contacts patient and/or clinic to advise if authorization request has not been obtained prior to date of service.
* Researches and works with appropriate stakeholders in initiating…