Prior Authorization Specialist I, Hospital Admissions, Full-Time

Community Hospital•Grand Junction, CO

13d•Onsite

About The Position

This is a full-time position in Hospital Admissions for a Prior Authorization Specialist I. The role involves gathering patient information, verifying insurance coverage, submitting pre-authorization requests, and following up with insurance providers. The specialist will also communicate with healthcare providers, educate patients about the process, maintain detailed records, and ensure compliance with regulations like HIPAA.

Requirements

High school diploma or equivalent.
Knowledge of medical terminology preferred.

Responsibilities

Collect and review patient medical records, diagnosis codes, and procedure details to support the pre-authorization request.
Confirm patient information and insurance coverage through verifying photo ID, insurance cards, and personal information.
Prepare and submit pre-authorization requests to insurance companies, adhering to their specific procedures and requirements.
Monitor the progress of pre-authorization requests and follow up with insurance providers to expedite the approval process.
Collaborate with healthcare providers to obtain any necessary documentation, notes, or additional information required for pre-authorization.
Explain the pre-authorization process to patients, including potential out-of-pocket costs, and address any questions or concerns they may have.
Maintain detailed records of pre-authorization requests, approvals, denials, and communications with insurance companies and healthcare providers.
Ensure that all pre-authorization processes comply with relevant laws and regulations, including HIPAA (Health Insurance Portability and Accountability Act).