Associate Patient Access Rep- Prior Authorizations

Community Health Network•Indianapolis, IN

About The Position

The Prior Authorization team member is responsible for obtaining and managing insurance authorization for medical services, procedures, and medications. This role ensures timely approvals, minimizes delays in patient care, and supports revenue cycle efficiency through accurate and compliant processing of authorization requests.

Requirements

High School Diploma or GED required.

Nice To Haves

Two years of experience in customer service or healthcare office setting preferred.
Prior Authorization or Patient Access experience preferred.
Experience with specialty services (radiology, surgery, infusion, etc.) preferred.
Familiarity with Epic or other healthcare systems preferred.

Responsibilities

Initiate and submit prior authorization requests to insurance companies for services, procedures, and medications.
Review provider orders and documentation to ensure medical necessity and completeness.
Verify insurance benefits and authorization requirements.
Communicate with payers, providers, and clinical staff to obtain required information.
Track authorization status and follow up to ensure timely approvals.
Document authorization details accurately in the system.
Resolve denials or incomplete requests by obtaining additional documentation or appealing when appropriate.
Maintain knowledge of payer policies and authorization guidelines.
Collaborate with scheduling, registration, and clinical teams to prevent delays in care.
Ensure compliance with organizational policies and regulatory requirements.