Prior Authorization Specialist

Jersey Community Hospital•Jerseyville, IL

About The Position

The Prior Authorization Specialist verifies patients’ insurance eligibility, benefits, and authorization requirements with insurance carriers, and secures prior authorizations before services are performed. The role communicates insurance changes and trends to the team and leadership, documents communications with providers and other personnel, and prioritizes time-sensitive authorizations. The specialist maintains proficiency in multiple EMR systems for demographic, insurance, and clinical information, as well as digital faxing, scanning, and instant messaging tools. Other roles and responsibilities may be assigned.

Requirements

High school graduate or equivalent.
Minimum of two years’ experience in a clinic or hospital billing, prior authorization, and/or insurance verification area.
Demonstrated communication and customer service skills.
Ability to follow oral or written instructions.
Ability to organize and interpret data, exercise judgment, tact, and diplomacy, and problem-solve.
Ability to work effectively in a team environment and communicate with a variety of professionals.
Knowledge of computers and software.

Nice To Haves

Certification through NAHAM, HFMA, or AHIMA.
Associate degree.
Demonstrated payer knowledge.

Responsibilities

Contact insurance carriers to verify patient insurance eligibility, benefits, and authorization requirements.
Secure prior authorizations before services are performed.
Communicate insurance changes and trends to the team and leadership.
Document communications and contacts with providers and other personnel.
Prioritize time-sensitive authorizations.
Maintain proficiency in multiple EMR systems for demographics, insurance, and clinical information.
Demonstrate proficiency in digital faxing, scanning, and instant messaging communication tools.
Perform other roles and responsibilities as assigned.