Prior Authorization Specialist

Texas Tech University • El Paso, TX

4d • Onsite

About The Position

The Prior Authorization Specialist verifies insurance coverage and eligibility and obtains required pre-authorizations for medical procedures, treatments, and services. The position is performed onsite at Texas Tech Health El Paso (TTEP); remote and hybrid arrangements are not available. TTEP is not considering applicants who require employment visa sponsorship, including individuals with H-1B visas or current student or postgraduate visas.

The specialist manages pre-authorization requests and follow-up, supports providers and patients with authorization-related questions, and maintains accurate records of requests, approvals, and denials. The role also reviews electronic health record work queues, supports billing compliance, monitors payer and coding requirements, and collaborates with revenue cycle and clinic administration teams to improve authorization processes.

The employee is expected to follow institutional policies and required trainings, demonstrate TTEP’s stated values, promote those values across the institution, and perform other duties as assigned.

Requirements

• Associate's degree plus one year of experience directly related to processing prior authorizations; or high school diploma or GED plus current PACS, CHAA, or CMA certification; or high school diploma or GED plus three years of experience directly related to patient registration, patient scheduling, patient billing/collections, and/or processing prior authorizations.
• PACS, CHAA, or CMA certification.
• Excellent verbal and written communication and interpersonal skills.
• Knowledge of basic medical terminology.
• Knowledge of CPT and ICD-10 coding.
• Familiarity with payer authorization processes.
• Ability to apply strong attention to detail while meeting required deadlines, targets, goals, and/or metrics.
• Ability to work onsite; remote and hybrid opportunities are not available.
• Applicants requiring employment visa sponsorship are not being considered.

Nice To Haves

• Previous experience supporting multiple medical sub-specialties or clinics.
• Previous experience working in an academic medical or health sciences center.
• Bilingual in English and Spanish.

Responsibilities

• Handle the authorization process and obtain pre-certification approvals before services are provided.
• Submit pre-authorization requests and follow up with payers to ensure timely approvals.
• Update resident providers and supervising faculty about pre-authorization delays.
• Assist providers in assessing treatment plans to determine whether pre-authorization is required.
• Assist with developing and maintaining a standardized pre-authorization workflow.
• Provide faculty, residents, and staff with instruction and guidelines on coding and pre-authorization processes.
• Assist with preparing and submitting appeals for denied authorizations, including providing additional information or documentation.
• Respond to and follow up on patient and insurance inquiries and correspondence in a timely manner and according to departmental expectations.
• Provide the leadership team with regular updates on authorization and denial status.
• Maintain accurate records and reports of pre-certification requests, approvals, and denials.
• Review assigned electronic health record work queues to clear errors and ensure billing is submitted in a timely manner and according to departmental expectations.
• Stay current with coding guideline changes, insurance regulations, and insurance requirements.
• Assess and monitor Medicaid/CHIP billing guidelines and regulations, partnering with the Office of Institutional Compliance on corrective action plans related to billing compliance.
• Collaborate with the revenue cycle team in meetings as directed to review payment and denial trends.
• Work with clinic administration on process improvements to optimize clinic pre-authorization processes.
• Communicate with patients about authorization requirements, status updates, and financial responsibilities associated with approved or pending authorizations.
• Serve as a liaison between clinical providers and insurance payers to address authorization-related issues and inquiries.
• Escalate concerns to leadership according to departmental expectations.
• Maintain required licensure and certifications and complete mandatory compliance and training requirements.
• Follow applicable policies, procedures, and practices, including Regents Rules, TTUS, and HSECEP OPs.
• Demonstrate Texas Tech Health El Paso’s values of Service, Respect, Accountability, Integrity, Advancement, and Teamwork, and promote those values across the institution.
• Perform other duties as assigned.

What This Job Offers

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