Authorizations Representative Lead

Whitman Hospital and Medical Clinics • Colfax, WA

10d • $24 - $42 • Onsite

About The Position

The Authorization Lead serves as both a working authorizations representative and team lead within Patient Financial Services. This position is responsible for completing insurance verification, obtaining prior authorizations, and ensuring compliance with payer requirements for specialty and hospital services at WHMC. In addition to managing their own workload, the Lead provides guidance, training, and workflow oversight for referral and authorization staff. The role functions as an Epic superuser, supports process improvement initiatives, and collaborates closely with clinical departments, scheduling, and the business office to minimize denials, enhance patient access, and optimize reimbursement.

Requirements

• High school diploma or equivalent.
• Three (3) years of experience in healthcare revenue cycle, referrals, authorizations, or patient financial services.
• Proficiency in Epic or similar EMR system.
• Strong knowledge of payer authorization and referral requirements.

Nice To Haves

• Associate’s degree in business, healthcare administration, or related field.
• Five (5) years of experience in healthcare revenue cycle, referrals, authorizations, or patient financial services.
• Prior experience in a Critical Access Hospital (CAH) or rural healthcare setting.
• Knowledge of CMS guidelines, insurance payer contract compliance, and medical necessity criteria.
• Demonstrated leadership or lead role experience.

Responsibilities

• Completing insurance verification, obtaining prior authorizations, and ensuring compliance with payer requirements for specialty and hospital services.
• Providing guidance, training, and workflow oversight for referral and authorization staff.
• Functioning as an Epic superuser.
• Supporting process improvement initiatives.
• Collaborating closely with clinical departments, scheduling, and the business office to minimize denials, enhance patient access, and optimize reimbursement.
• Entering authorization information into the patient accounting system, including effective dates, authorized visits, patient information, billing information, and other authorization requirements.
• Ensuring authorization has not expired for the scheduled patient visits.
• Following proper patient/beneficiary notice procedures for potential non-coverage.
• Communicating authorization information to appropriate staff as needed.
• Obtaining authorizations from insurance companies/physicians/medical benefits Management Company.
• Coordinating with billers regarding denials.
• Researching denials and facilitating retro-authorization or appeals.
• Reviewing authorization-related denials and coordinating corrective actions with staff and departments.
• Working with providers and schedulers to prevent denials (e.g., CPT/diagnosis mismatches, missing authorizations).
• Tracking and reporting denial trends, providing recommendations to leadership.
• Identifying workflow gaps and implementing process improvements to streamline referral and authorization functions.
• Ensuring compliance with CMS, Medicaid, Medicare Advantage, and commercial payer regulations.
• Collaborating with Revenue Cycle leadership to support organizational goals (e.g., reducing denial rates, improving cash flow).
• Reviewing daily work queues to ensure timely completion of referrals and prior authorizations.
• Monitoring scheduled and unscheduled services to confirm payer requirements are met before patient care.
• Ensuring urgent and same-day authorization requests are prioritized and completed efficiently.
• Providing expertise to staff on payer-specific rules, medical necessity, and documentation requirements.
• Training, mentoring, and supporting staff on Epic referral/authorization workflows, payer requirements, and hospital policies.
• Providing team performance feedback to supervisor as requested.
• Acting as a liaison between clinical areas, Patient Financial Services, and the Business Office teams.
• Assisting in development of department schedule and other assigned staffing needs.
• Serving as preceptor for new staff.
• Provides guidance and education for existing staff.
• Assisting in identifying department process improvements.
• Providing guidance to others in same position.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Life insurance
• Retirement options (403(b) & 457)
• Discounts on medical services provided by Whitman Hospital and Medical Clinics
• Unique PTO plan that enables employees to increase their accrual with each year of service

What This Job Offers

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