Patient Processing Prior Authorization Spec- Pinnacle Cardio

East Alabama Hospital • Opelika, AL

2d

About The Position

The PPS authorization specialist is responsible for ensuring an efficient, accurate, and complete pre-registration and/or authorization process for patients within East Alabama. This role involves verifying patient demographic and insurance information, obtaining timely insurance authorizations, pre-certifications, and referrals for scheduled and emergent services, and confirming insurance coverage prior to services being rendered. The specialist serves as a liaison between patients, providers, and insurance carriers to secure required approvals, explain benefits and out-of-pocket responsibilities, and ensure compliance with payer requirements. This position plays a critical role in preventing claim denials, supporting financial transparency for patients, and promoting the delivery of uninterrupted, high-quality patient care.

Requirements

• High School Diploma or equivalent
• 1-2 years customer service experience
• 1-year computer experience
• Ability to type and spell accurately

Nice To Haves

• Associate Degree in Business or Health related field
• Knowledge of Medical Terminology
• Knowledge of ICD-10 and CPT coding
• 1-2 years healthcare/hospital experience and/or customer service experience
• Insurance verification and authorization experience

Responsibilities

• Verifying patient demographic and insurance information
• Obtaining timely insurance authorizations, pre-certifications, and referrals for scheduled and emergent services
• Confirming insurance coverage prior to services being rendered
• Serving as a liaison between patients, providers, and insurance carriers to secure required approvals
• Explaining benefits and out-of-pocket responsibilities
• Ensuring compliance with payer requirements
• Preventing claim denials
• Supporting financial transparency for patients
• Promoting the delivery of uninterrupted, high-quality patient care

What This Job Offers

• Career Level: Entry Level
• Education Level: High school or GED