Prior Authorization Specialist
About The Position
Bartlett Regional Hospital is searching for an Prior Authorization Specialist to join our Prior Authorization Team! Prior Auth Specialist 1: The Prior Authorization Specialist 1 performs routine prior authorization and insurance verification functions in support of patient access and revenue cycle operations. Under general supervision, this role determines authorization requirements, verifies insurance coverage and eligibility, submits standard requests, and monitors status to ensure timely processing and scheduling. The position follows established workflows, ensures required documentation is complete, communicates updates with staff and payers, and escalates complex issues as needed while developing foundational knowledge of payer requirements, insurance verification, and authorization processes. Prior Auth Specialist 2: The Prior Authorization Specialist 2 independently manages prior authorization and insurance verification processes across multiple service lines, ensuring accurate eligibility determination, timely approval of services, and minimal delays in patient care. This role applies advanced knowledge of payer requirements, benefit structures, clinical documentation standards, and authorization workflows to resolve complex issues, including denials, coverage discrepancies, and incomplete requests. The Specialist 2 serves as a resource to staff and providers on authorization and insurance-related questions, supports process improvement efforts, and helps identify trends impacting access and reimbursement. This position is responsible for ensuring accuracy, compliance, and efficiency across all authorization and insurance verification activities.
Requirements
- High School diploma or equivalent
- One (1) year of experience in data entry, billing, accounting, or similar experience (for Specialist 1)
- One (1) year of direct prior authorization experience in a hospital (for Specialist 2)
- Produce a negative drug screen for all illegal substances in the State of Alaska prior to start of employment
Nice To Haves
- Foundational knowledge of payer requirements, insurance verification, and authorization processes (for Specialist 1)
- Advanced knowledge of payer requirements, benefit structures, clinical documentation standards, and authorization workflows (for Specialist 2)
Responsibilities
- Determines authorization requirements
- Verifies insurance coverage and eligibility
- Submits standard requests
- Monitors status to ensure timely processing and scheduling
- Follows established workflows
- Ensures required documentation is complete
- Communicates updates with staff and payers
- Escalates complex issues as needed
- Manages prior authorization and insurance verification processes across multiple service lines
- Ensures accurate eligibility determination
- Ensures timely approval of services
- Resolves complex issues, including denials, coverage discrepancies, and incomplete requests
- Serves as a resource to staff and providers on authorization and insurance-related questions
- Supports process improvement efforts
- Helps identify trends impacting access and reimbursement
- Ensures accuracy, compliance, and efficiency across all authorization and insurance verification activities
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
