Prior Authorization Specialist

Prior Authorization Specialist

Hot Job

Administration Building - Grants Pass, OR

Overview

Position Type Full Time

Description

Job Title: Prior Authorization Specialist Reports To: Health Information and Care Coordination Manager Location: Grants Pass, Oregon – 557B NE Westbrook Way Hawthrone Ave. Grants Pass, OR, 97527 Job Type: Full Time FLSA Status: Non-Exempt Pay Range: $18.35-$25.00/hour Schedule: Monday-Friday 8:00 AM – 5:00 PM

Job Summary: The Prior Authorization Specialist is responsible for coordinating and obtaining prior authorizations for medications and diagnostic imaging services, as well as processing imaging referrals. This role plays a key part in ensuring timely access to patient care by facilitating authorization requests, coordinating with insurance providers, and supporting an efficient referral process.

Essential Functions:

• Processes and monitors medication prior authorization requests through CoverMyMeds and other insurance authorization platforms.
• Coordinates prior authorizations for diagnostic imaging services, ensuring timely submission of required documentation.
• Processes and tracks imaging referrals, coordinating with providers, insurance companies, and imaging facilities to support timely patient care.
• Reviews authorization requests for accuracy and completeness, obtaining additional clinical documentation as needed.
• Communicates with providers and clinical staff regarding authorization requirements, pending requests, approvals, denials, and necessary follow-up.
• Follows up with insurance companies to resolve authorization delays, documentation discrepancies, and outstanding requests.
• Accurately documents prior authorizations, referral activities, and medication refill-related information in the Electronic Health Record (EHR).
• Maintains organized records and prioritizes requests to ensure timely processing and completion.
• Ensures compliance with HIPAA regulations, patient confidentiality standards, and organizational policies.
• Performs other duties as assigned.

Working Conditions:

• Work Environment: 100% office-based position with continuous interaction with patients. Work is primarily conducted at a designated workstation utilizing computers, electronic health records, telephones, and other standard office equipment. Regular interaction with healthcare providers, clinical staff, insurance representatives, pharmacies, and external healthcare organizations is required. The position involves managing multiple requests and deadlines in a fast-paced healthcare environment while maintaining accuracy and attention to detail.
• Travel Requirements: Primarily office-based; occasional local travel may be required as needed.
• Physical Demands: Prolonged periods of sitting and working at a computer workstation. Frequent use of hands and fingers for typing, data entry, operating office equipment, and handling documents. Ability to stand, walk, sit, bend, reach, push, carry, and lift as required to perform job duties. Ability to maintain physical mobility throughout the office. Vision and hearing must be within functional range, with corrective devices as needed.

Qualifications

Required Education and Experience

• Education: High School Diploma or equivalent GED.

• Experience: Previous experience in a healthcare, medical office, pharmacy, or administrative support setting preferred. Experience processing medication prior authorizations, insurance verification, medical referrals, or insurance-related documentation preferred. Familiarity with Electronic Health Record (EHR) systems and healthcare documentation practices preferred. Experience working with insurance companies, including Medicaid, Medicare, and commercial insurance plans, preferred. Experience utilizing CoverMyMeds or similar prior authorization platforms preferred.

Knowledge & Skills

• Knowledge of medical terminology, medications, insurance processes, and prior authorization requirements.
• Familiarity with Electronic Health Records (EHR), CoverMyMeds, and standard computer applications.
• Strong organizational, time-management, and multitasking skills with attention to detail.
• Effective communication, customer service, and problem-solving skills.
• Ability to work independently and collaboratively in a fast-paced healthcare environment.
• Understanding of HIPAA regulations, patient confidentiality, and privacy requirements.

Comprehensive Benefits Package

At Siskiyou Community Health Center, we're committed to supporting the health, financial well-being, and work-life balance of our employees. Our comprehensive benefits package includes:

• Medical, Dental & Vision Insurance
• Health Savings Account (HSA) & Flexible Spending Account (FSA)
• 403(b) Retirement Plan & Retirement Savings Opportunities
• Paid Time Off, Holiday & Paid Sick Time
• Family Leave
• Employee Assistance Program (EAP)
• Life Insurance
• Employer paid Mercy Flights Membership
• Tuition Reimbursement & Professional Development Support
• Mileage Reimbursement

Pre-Employment Requirements: Employment is contingent upon successful completion of a post-offer background check, employment verification, and drug screening. The drug screening must produce a negative result for marijuana and other substances prohibited by the organization's drug-free workplace policy.

At-Will Employment: Siskiyou Community Health Center is an 'At-Will' employer. Nothing in this job description should be interpreted as an employment contract.