Prior Authorization Tech

Republic County Hospital•Belleville, KS

21h

About The Position

The Prior Authorization Tech works under the supervision of the HIM Manager in the Health Information Management department. The role reviews requests for medical services, medications, or procedures to ensure they meet clinical criteria, payer rules, and regulations before approval. The position serves as a link between providers, patients, and insurers to facilitate necessary care while managing costs and documentation. Work often involves phone calls, record review, and data entry in health systems. The role does not supervise other employees and works cooperatively with clinic and hospital departments, medical staff, patients, and visitors. The position requires administrative skills, attention to detail, data entry, and insurance verification and coordination. The job description states that its lists of responsibilities and requirements are not exhaustive and may be supplemented as necessary.

Requirements

High school diploma or equivalent.
Excellent written and verbal communication skills.
Strong critical-thinking and problem-solving skills.
Strong organizational, planning, time-management, and prioritizing skills.
Proficiency in Microsoft Office and patient management software and databases.
Administrative skills, attention to detail, data-entry skills, and insurance verification and coordination.
Occasionally exposed to the risk of blood-borne diseases; has contact with patients under a wide variety of circumstances and may be exposed to unpleasant elements such as accidents, injuries, and illness; subject to varying and unpredictable situations.
Light to medium physical effort, including lifting or carrying up to 50 pounds; occasional standing and walking; occasional lifting of supplies or equipment; eye-hand coordination.

Nice To Haves

Previous experience in a healthcare setting is preferred.
An associate's degree or certification in medical billing, coding, or healthcare administration is preferred.
Certifications preferred: CPC, CCA, or CMAA.
Understanding of medical terminology and coding is beneficial.

Responsibilities

Receive, process, and log authorization requests for services, medications, or procedures.
Review patient records, gather necessary documentation, and process requests.
Contact providers, pharmacies, or patients to obtain missing clinical documentation or clarification.
Handle phone calls with insurance providers.
Accurately enter and update patient and authorization data in medical management systems.
Coordinate with providers, administrators, and sometimes patients by phone, fax, or electronic portals.
Track pending requests and follow up to support timely approval.
Assist with HCAHPS, quality projects, and other duties as assigned.
Verify patient eligibility and benefits.
Act as a liaison between providers, patients, and the clinical team.
Assist in assembling and submitting necessary paperwork.