Prior Auth Specialist

Nationwide Children's Hospital • Toledo, OH

1d

About The Position

The Prior Auth Specialist processes pre-authorizations for exams or services ordered by providers and performed at any NCH facility. The role ensures pre-authorizations are completed appropriately through communication with third-party payers and collaboration with clinics. This is a part-time position working 20 hours per week. Hours have some flexibility, but availability on Mondays and Fridays is required.

Requirements

• High school diploma or equivalent.
• Excellent customer service and communication skills.
• Ability to work and problem-solve with minimal supervision.
• Ability to understand and retain complex, quickly changing information.
• Knowledge of the impact of the revenue cycle on hospital operations.
• Familiarity with medical terminology.
• Ability to function as a team member responsible for staffing operational hours.
• Ability to adapt positively to changes in workflow and process.
• Keyboarding, typing, or data-entry skills.

Nice To Haves

• Associate's degree.
• One year of pre-registration, registration, admitting, or customer service experience.
• One year of experience in billing processes and insurance verification.
• Working knowledge of HIS Work Queues.

Responsibilities

• Participate in the pre-authorization documentation process by obtaining, compiling, maintaining, and issuing necessary records and reports, ensuring accuracy and correct distribution.
• Document pre-authorization information appropriately in the hospital information system (HIS).
• Contact third-party payers to obtain pre-authorization for ordered exams and provide updates as needed throughout the process.
• Review pending pre-authorizations and follow up when needed.
• Notify clinics when a peer-to-peer review is requested and review clinic progress on pre-authorizations requiring additional details for approval.
• Provide Patient Accounts with additional information to assist with billing issues involving pre-authorization.

What This Job Offers

• Job Type: Part-time
• Education Level: High school or GED