Specialist, Prior Authorization

Lifepoint Health • Wilson, NC

1d • Onsite

About The Position

At Lifepoint Health, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. As a member of the Health Support Center (HSC) team, you’ll support those that are in our facilities who are interfacing and providing care to our patients and community members to positively impact our mission of making communities healthier ®.
Job Summary:
The Prior Authorization Specialist works with departments and insurance companies to obtain the necessary pre-certifications and authorizations for services ordered/scheduled. Once received these are recorded in Paragon to ensure appropriate billing. The Prior Authorization Specialist maintains a high level of understanding of insurance companies and billing authorization requirements

Requirements

• Hish School Diploma Required
• One year of experience preferred

Responsibilities

• Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization
• Notification, and pre-certifications for identified patients.
• Follows up with physician offices, financial counselors, patients, and third-party payers to complete the pre-certification process
• Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements/on-line eligibility systems.
• Educates patients, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
• Ensures all services have prior authorizations and updates patients on their preauthorization status.
• Coordinates peer to peer review if required by insurance. Notifies patient accounts staff/patients of insurance coverage lapses, and self-pay patient status. May notify ordering providers if authorization/certification is denied.
• May coordinate scheduling of patient appointments, diagnostic and/or specialty appointments, tests and/or procedures.
• Maintains files for referral and insurance information and enters referrals into the system.
• Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.

Benefits

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage — with medical plans starting at just $10 per pay period — tailored benefit options for part-time and PRN employees, and more.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.
• Tuition Reimbursement : Available for full and part time employees to further education.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED