Prior Authorization Specialist

Job Summary

To support the Revenue Cycle Patient Access team, the part-time Prior Authorization Specialist I will coordinate financial clearance activities by navigating referral, precertification, and authorization requirements, while ensuring compliance with payer-specific guidelines and maintaining productivity standards.

Key responsibilities

• Monitors and clears work queues by obtaining payer-specific financial clearance requirements for precertifications and prior authorizations
• Acts as a subject matter expert in navigating payer requirements to facilitate patient access to services
• Collaborates with patients, providers, and departments to obtain necessary information and permissions prior to scheduled services

Required qualifications

• High School Diploma or GED required; Associate's degree or higher preferred
• 4-5 years of experience in medical billing, coding, or inpatient admitting desirable
• General knowledge of healthcare terminology and CPT-ICD10 codes
• Case manager and/or coding certification desirable
• Knowledge of and experience within Epic preferred