Inpatient Prior Authorization Specialist (Full Time)

North Country Healthcare • Berlin, NH

5d

About The Position

The Prior Authorization Specialist plays a crucial role in the healthcare
administration process by ensuring that all necessary pre-authorizations for
procedures, medications, and services are obtained efficiently. This position
involves coordinating between healthcare providers, insurance companies, and
patients to facilitate timely access to healthcare while ensuring compliance
with all regulatory requirements. The specialist will work in a fast-paced
environment and must possess excellent organizational and communication skills
to manage a high volume of authorization requests.

Requirements

• High school diploma or equivalent required.
• Strong knowledge of insurance verification processes and medical terminology.
• Proficient in the use of healthcare management software and electronic health records (EHR) systems.
• Excellent verbal and written communication skills.
• Strong analytical abilities and attention to detail.
• Ability to handle confidential information with discretion.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook)
• Association accredited course in Basic Life Support (BLS) (for clinical staff), orHeartsaverCPR AED (for nonclinical staff), and renewal on a regular basis, with up to a three-month grace period after the expiration date.

Nice To Haves

• Associate’s or higher in healthcare administration, business, or related field preferred.
• Certification in Medical Billing and Coding, Certified Medical Administrative Assistant (CMAA), Licensed Nursing Assistant (LNA),or a similar credential is preferred.
• Minimum of 2 years’ experience in prior authorization, medical billing, or a related field within a healthcare setting preferred
• Experience working with insurance companies and understanding various health plans and benefits preferred

Responsibilities

• Initiate and process prior authorization requests from healthcare providers for medical services, medications, and procedures.
• Communicate with insurance companies to verify patient benefits, eligibility, and obtain necessary pre-approvals.
• Analyze insurance policies and guidelines to determine requirements for prior authorizations.
• Collaborate with healthcare providers to provide the necessary documentation and information required by payers.
• Follow up on pending authorizations and ensure timely resolution of missing information or denied requests.
• Document and track all authorization requests in the appropriate EHR systems.
• Advocate for patients by ensuring requests are reviewed accurately and efficiently to avoid delays in treatment.
• Provide clear and concise updates to case management staff regarding the status of authorization requests.
• Maintain up-to-date knowledge of payer policies, procedures, and industry trends related to pre-authorization requirements.
• Respond promptly to inquiries from patients, healthcare providers, and insurance companies, ensuring compliance with HIPAA and other regulatory requirements in all communications and documentation.
• Contribute to process improvement initiatives aimed at increasing efficiency and effectiveness of the prior authorization process.
• Assist with training and onboarding new staff as needed.
• Monitor and report on trends related to prior authorization denials and approvals to leadership.
• Assist and support the Employee Health Department with drug screenings as needed.
• Assist and support the Infection Control Department with clerical duties, surgical site letters, lines and drain tracking, scanning, and precautions for rounding.
• Performs additional duties as assigned.
• Adheres to facility Values, Service Excellence, and Standards of Excellence.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees