Prior Authorization Specialist

Rapid City Medical Center•Rapid City, SD

1d•Onsite

About The Position

Rapid City Medical Center has a Full-Time, Prior Authorization Specialist position available. This position is responsible for managing the prior authorization process. It serves as an integral part of the patient care team while acting as a liaison between patients, scheduling, radiology, and clinical staff to deliver outstanding service and optimize patient flow. While working under general supervision, this position requires utilizing reasoning skills to identify missing or needed information and relying on policies and procedures to work independently to secure prior authorizations and use various business applications to perform analysis and enter necessary data. Position is on-site. Who We Are Rapid City Medical Center is a physician clinic dedicated to excellence, choice, and patient-centered care. We prioritize building strong relationships with our patients, partnering with them throughout their health journey. Our team of 90 physicians and advanced practice providers, supported by over 400 employees, combines leading-edge technology with medical expertise to ensure efficient and effective appointments and smooth insurance interactions. We thrive on collaborating with smart, compassionate individuals. Our work can be challenging, but we are motivated by serving our families, friends, and community in meaningful ways. We value work-life balance and career satisfaction, offering competitive wages, exceptional benefits, and a workplace where you can feel proud of your contributions. Our benefits package includes health, dental, and vision insurance, 401(k) with profit sharing, life insurance, short- and long-term disability coverage, seven paid holidays plus a floating birthday, paid time off (PTO), and flexible scheduling to support important personal and family milestones.

Requirements

Minimum of one year work experience in medical service.
Experience in business/professional written and verbal communication.
General understanding of medical terminology, insurance billing, or coding background desirable.
Exceptional customer relation skills.
Intermediate level of computer knowledge with experience in Microsoft Office Products.
Ability to walk, stand, and sit for periods of time. Ability to sit and review information on a computer screen for extended periods of time.
Normal motor skills and eye-hand coordination.
Must have manual dexterity to operate computer keyboard and standard office equipment.
Occasional stress from dealing with multiple projects.

Responsibilities

Serves as a member of the clinic care team by providing service that further facilitates the ongoing care of that patient.
Initiates prior authorizations as required by payers for diagnostic imaging procedures and specialized medications.
Accurately processes prior authorization requests in accordance with RCMC policy and procedures and communicates back to nurse/provider team in a timely manner.
Accountable to achieve prior authorization processing productivity and accuracy standards.
Protects and maintains confidentiality and privacy of all prior authorization and member information.
Demonstrates ability to appear for work on time, knowledge of medical terminology, follow directions from a supervisor and interact well with coworkers and patients.
Develop, document, and maintain a prior authorization matrix for all payers.
Maintains confidentiality of all pertinent information to assure that employee, patient, and visitor rights are protected.
Handles all information regarding the organization in a manner that assures strictest confidentiality is maintained at all times.
Other responsibilities as assigned based on business needs.