Prior Authorization Tech

Republic County Hospital•Belleville, KS

2d•Onsite

About The Position

The Prior Authorization (PA) Tech works under the supervision of the HIM Manager. The PA Tech reviews requests for medical services, medications, or procedures, ensuring they meet clinical criteria, payer rules, and regulations before approval, acting as a crucial link between providers, patients, and insurers to facilitate necessary care while managing costs and documentation, often involving phone calls, record review, and data entry in health systems.

Requirements

High School Diploma or equivalent
Excellent written and verbal communication skills
Strong critical thinking and problem-solving.
Strong organizational, planning, time management and prioritizing skills
Proficiency in MS Office and patient management software and databases.
Understanding of medical terminology and coding. (beneficial)
(PA) Tech role requires administrative skills with attention to detail, data entry, and insurance verification and coordination.

Nice To Haves

Previous experience in a healthcare setting is preferred.
Associate's Degree or certified in medical billing, coding, or healthcare administration, preferred.
Certifications preferred in the following areas: CPC, CCA, CMAA.

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 for missing clinical documentation or clarification.
Handles phone calls with insurance providers.
Data entry, accurately update patient and authorization data in medical management systems.
Coordinate with providers, administrators and sometimes patients via phone, fax or electronic portals.
Track pending requests and follow up to ensure 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.