Prior Authorization Specialist (Full-Time Days)

Mille Lacs Health System•Onamia, MN

About The Position

The Prior Authorization Specialist works under the direction of the Health Information Manager. This role ensures that payers are prepared to reimburse Mille Lacs Health System for scheduled services in accordance with payer-provider contracts. Responsibilities include requesting service authorizations, preparing, and submitting documentation, and managing appeals. The position requires strong communication, insurance knowledge, and the ability to work independently and collaboratively in a fast-paced healthcare environment.

Requirements

Medical Assistant (MA) certification or Licensed Practical Nurse (LPN) licensure in the State of Minnesota
Minimum 1-2 years of prior authorization experience in a healthcare setting
Experience with medical terminology and insurance processes
Strong verbal and written communication skills
Proficient computer and business skills
Ability to manage multiple priorities and work independently or in a team
Knowledge of insurance eligibility and HIPAA compliance

Nice To Haves

5 years of prior authorization experience
5 years of experience in a healthcare setting
Detail-oriented and self-directed
Ethical conduct and professionalism
Initiative and flexibility
Time management and stress management
Teamwork orientation and technical capacity
Quality and safety focused

Responsibilities

Receive and monitor prior authorization requests in accordance with MLHS standards.
Review accuracy and completeness of documentation and ensure all supporting materials are present.
Assist with medical necessity documentation to expedite approvals.
Collaborate with departments and providers to obtain authorizations and support appeals.
Write and submit appeals to insurance providers, including physician input when needed.
Manage correspondence with insurance companies and document all interactions in the EMR.
Record prior authorization details including approval dates, billing units, procedure codes, and authorization numbers.
Review insurance denials and proactively submit appeals.
Track and renew expiring authorizations.
Work closely with other staff performing prior authorization functions.
Secure patient demographics and medical information in compliance with HIPAA regulations.
Complete all required duties, projects, and reports in a timely manner.
Attend mandatory meetings and complete required training.