PRIOR AUTHORIZATION SPECIALIST- REMOTE POSITION-FT

Memorial Regional Health • Craig, CO

235d • $20 - $30 • Remote

About The Position

This remote position is responsible for obtaining prior authorizations and pre-certifications as per payer requirements for physician-ordered procedures. The role involves verifying physician orders, authorization, and demographic information before sending it to the hospital scheduling department. The individual will maintain communication with providers, clinical staff, and patients regarding authorization status and assist the billing department in researching and resolving rejected, incorrectly paid, and denied claims. The position requires staying current with insurance requirements for prior authorizations and providing education within the department and to clinical staff on any changes. Efficient tracking of all pending authorizations is essential to ensure timely resolution, along with performing other duties as assigned.

Requirements

• Must be at least 16 years of age (21 for driving positions).
• Must be able to legally work in the United States.
• Must be able to pass a background check.
• Must be able to pass a drug screen and breath alcohol test (if applicable).
• Must complete employee health meeting.
• High School Diploma or equivalent preferred.
• Past knowledge of CPT, HCPCS, and ICD-10 codes.
• Past knowledge of Medical Terminology.
• Past experience in the prior authorization process.
• Past experience with Microsoft Office to include Word, Excel, and PowerPoint helpful.
• Data entry experience.

Nice To Haves

• Bilingual.

Responsibilities

• Obtains prior authorizations/pre-certification per payer requirements for physician ordered procedures.
• Verifies physician orders, authorization, and demographic information before sending to the hospital scheduling department.
• Maintains communication with providers, clinical staff, and patients regarding authorization status.
• Assists the billing department in researching and resolving rejected, incorrectly paid, and denied claims.
• Stays current with insurance requirements for prior authorizations and provides education within the department and to clinical staff.
• Maintains efficient tracking of all pending authorizations to ensure timely resolution.
• Performs other duties as assigned.

Benefits

• Medical
• Dental
• Life
• Retirement
• Paid Time Off

What This Job Offers

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