Prior Authorization Specialist

Mountain Area Health Education Center - MAHEC • Asheville, NC

19h • Onsite

About The Position

This position will be requesting prior authorizations for services provided at MAHEC and services referred outside of MAHEC Service Lines. The role involves obtaining and requesting prior authorizations for in-house procedures, Medicare HMO visits, radiology, and behavioral health. It requires partnering with clinics and the referrals team to acquire necessary prior authorizations, ensuring approvals, and addressing any denials. The specialist will also assist with Peer-to-Peer requests and Appeals, and may support other areas needing prior authorizations and referrals.

Requirements

• Some college and/or equivalent experience in the healthcare field such as Prior Authorization Experience, experience in Human Services or Healthcare Administration, with a focus on Utilization Review.
• Basic typing, Microsoft Office Suite (Outlook, Excel, Word, PPT), Data Entry Required.
• Regular attendance on-site is an essential function of this position.
• Must receive the Flu vaccine or have an approved exemption.
• Provide valid, original I-9 documents on their first day of work.

Nice To Haves

• Allscripts EHR experience preferred.
• Previous experience in prior authorizations is preferred.
• Fluency in Spanish a plus.

Responsibilities

• Obtaining and requesting prior authorizations for in-house procedures, Medicare HMO visits, radiology, and behavioral health.
• Partnering with clinics and the referrals team to acquire necessary prior authorizations.
• Ensuring authorizations are approved and working on any denials that are received.
• Assisting with any Peer-to-Peer requests and Appeals that are received.
• Supporting other areas needing prior authorizations and referrals.

Benefits

• Total Rewards (pay + benefits) to honor their service, support their health, manage their financial security, build their career, and thrive.
• Qualifying employer for the Public Service Loan Forgiveness (PSLF) Program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree