Prior Authorization Specialist

Cherry County Hospital and Clinic•Valentine, NE

19h•$21•Onsite

About The Position

Cherry County Hospital is seeking a dedicated and skilled Prior Authorization Specialist to join our team. In this vital role, you will be responsible for obtaining pre-certifications and pre-authorizations for medical procedures and medications at our hospital and clinic. Duties and Responsibilities: As a Prior Authorization Specialist, you will: Contact insurance carriers to verify patient insurance eligibility, benefits, and requirements Request, track, and obtain pre-authorizations for medical procedures and services Follow up with insurance carriers to ensure timely authorizations before services are performed Demonstrate a solid understanding of medical terminology and office procedures, including HIPAA regulations Communicate any insurance changes or trends to relevant departments Maintain a level of productivity suitable for the department Appeal insurance/payor denials when applicable Document all communications and contacts in a standardized format Notify department heads of any additional staffing or equipment needs Assist with occasional filing or record retrieval as needed Cooperate and work effectively with staff, public, and physicians Ensure the confidentiality of all patient medical, personal, and financial records Practice and adhere to corporate compliance policies and procedures Perform additional duties as assigned by the supervisor

Requirements

High school diploma required
Excellent verbal and written communication skills
Proficiency with computers and related software (Microsoft Excel, Word, and Windows)
Strong organizational skills and the ability to interpret data
Strong judgment, tact, diplomacy, and problem-solving skills
Ability to work collaboratively in a team environment
Strong attention to maintaining confidentiality of hospital and patient information
Ability to perform repetitive tasks with minimal independent judgment
Familiarity with state and federal confidentiality laws, including HIPAA, and the ability to follow policies regarding the privacy and security of health information
Sedentary work involving periods of sitting, talking, typing, and listening
Repetitive use of hands, arms, and eyes, which may cause strain
Significant manual dexterity to operate business office machines and equipment

Nice To Haves

Prior customer service experience in a medical setting preferred
Knowledge of medical terminology preferred
Previous experience with Microsoft Excel, Word, and Windows

Responsibilities

Contact insurance carriers to verify patient insurance eligibility, benefits, and requirements
Request, track, and obtain pre-authorizations for medical procedures and services
Follow up with insurance carriers to ensure timely authorizations before services are performed
Demonstrate a solid understanding of medical terminology and office procedures, including HIPAA regulations
Communicate any insurance changes or trends to relevant departments
Maintain a level of productivity suitable for the department
Appeal insurance/payor denials when applicable
Document all communications and contacts in a standardized format
Notify department heads of any additional staffing or equipment needs
Assist with occasional filing or record retrieval as needed
Cooperate and work effectively with staff, public, and physicians
Ensure the confidentiality of all patient medical, personal, and financial records
Practice and adhere to corporate compliance policies and procedures
Perform additional duties as assigned by the supervisor