Prior Authorization Specialist

BOONE MEMORIAL HOSPITAL INC•Madison, WV

1d•Onsite

About The Position

Boone Memorial Health is seeking a detail-oriented and organized Prior Authorization Specialist to join our Referral Department. This position plays a critical role in supporting patient care by coordinating referrals, obtaining prior authorizations, scheduling appointments, and ensuring all required documentation is complete and accurate. The Prior Authorization Specialist serves as a liaison between patients, providers, specialists, and healthcare teams to facilitate timely access to services and promote a positive patient experience.

Requirements

High school diploma or equivalent.
Excellent verbal and written communication skills.
Strong organizational, analytical, and problem-solving abilities.
Ability to manage multiple priorities in a fast-paced environment.
Proficiency with Microsoft Office and computer systems.
One or more years of experience in healthcare or a related field.
Knowledge of ICD-10 and CPT coding.

Nice To Haves

Associate degree in Medical Office Administration or a related field preferred.

Responsibilities

Receive, process, schedule, and follow up on referrals for diagnostic testing, specialists, and other healthcare services.
Obtain and process prior authorizations and required documentation.
Maintain accurate referral logs and patient records.
Coordinate appointments and communicate with patients, providers, and specialists.
Answer phones, emails, and faxes in a timely and professional manner.
Review referrals for completeness and accuracy, ensuring all necessary coding, physician notes, and supporting documentation are included.
Enter patient information into electronic medical records and other required systems.
Share patient information with referring specialists in accordance with HIPAA guidelines.
Maintain current knowledge of ICD-10 and CPT coding practices.
Collaborate effectively with providers and other departments to support quality patient care.
Comply with all organizational policies, regulatory requirements, and ethical business practices.