Specialist, Prior Authorization

Lifepoint Health • Winchester, KY

10h

About The Position

The Prior Authorization Specialist works collaboratively with clinical
departments and insurance providers to obtain required pre-certifications and
authorizations for scheduled services. This role ensures all authorizations are
accurately documented in the system to support proper billing and reimbursement.

The specialist maintains a strong understanding of payer requirements, insurance
policies, and authorization processes to ensure compliance and efficiency.

Requirements

• High School Diploma or equivalent (Required)
• Knowledge of Medicare, Medicaid, and third-party payer requirements
• Strong attention to detail and accuracy
• Excellent communication and customer service skills
• Ability to manage multiple tasks and meet deadlines
• Proficiency with electronic medical records and eligibility systems
• Problem-solving and critical thinking skills

Nice To Haves

• One (1) year of experience in healthcare, insurance verification, or prior authorization (Preferred)

Responsibilities

• Contact insurance carriers to verify benefits, policy limitations, and obtain authorizations/pre-certifications
• Follow up with physician offices, financial counselors, patients, and third-party payers to complete authorization processes
• Ensure all information is accurate and complete, applying knowledge of Medicare, Medicaid, and commercial payer requirements
• Educate patients, staff, and providers on authorization requirements, eligibility guidelines, and payer policies
• Monitor and confirm that all scheduled services have appropriate prior authorizations
• Coordinate peer-to-peer reviews when required by insurance companies
• Notify appropriate parties of authorization denials, coverage lapses, or self-pay status
• Assist with scheduling diagnostic tests, procedures, and specialty appointments as needed
• Maintain accurate referral and insurance records in the system
• Stay up to date on payer guidelines, insurance plans, and authorization requirements

Benefits

• Comprehensive Health Coverage: Medical, dental, and vision plans (starting at low cost options)
• Financial Protection: Life, accident, disability, and critical illness coverage
• Paid Time Off & Leave: Generous PTO and paid family leave
• Retirement Planning: 401(k) with company match
• Tuition Assistance: Education support for career advancement
• Wellness Programs: Free gym memberships, mental health services, and virtual care
• Employee Assistance Program: Support for mental, physical, and financial well-being
• Additional Perks: Discount programs, free parking, and more

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED