Job Description

Prior Authorization Specialist

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:

• 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

Skills and Abilities:

• 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

Physical Demands and Working Conditions:

• 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

Comprehensive Benefit Package:

• Health Insurance: Co-pay or HSA plan options: 100% paid for Employee
• Dental: 100% paid for Employee
• Vision: 100% paid for Employee
• $50,000 Group Life Insurance with AD&D
• Long-Term Disability: 100% paid for Employee
• Medical and Dependent Care Flexible Spending Accounts
• Health Savings Account with employer contribution
• Supplemental Insurances: Short-Term Disability, Supplemental Life and AD&D, Critical Illness, Hospital Indemnity and Accident
• Retirement Plan: 457 plan Pre-Tax and Roth options

Why Cherry County Hospital?

• Be part of a dedicated, compassionate healthcare team
• Competitive pay and excellent benefits
• Work in a collaborative and supportive environment

Requirements:

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

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