Prior Authorization Specialist - Onsite

Job Description

Job Description

Description:

Location: Cherry County Hospital, Valentine, NE
Position: Full-Time (40 hours/week) – Onsite
Compensation: Competitive wage based on experience
Benefits: Eligible for benefits

Now Hiring – Prior Authorization Specialist: About the Position

Cherry County Hospital is seeking a dedicated and detail-oriented Prior Authorization Specialist to join our team. In this important role, you will be responsible for obtaining pre-certifications and pre-authorizations for medical procedures and medications at our hospital and clinic.

As a Prior Authorization Specialist, you will:

• Contact insurance carriers to verify patient eligibility, benefits, and requirements.
• Request, track, and obtain pre-authorizations for medical procedures and services.
• Follow up with insurance carriers to ensure timely authorizations before services are performed.
• Demonstrate knowledge of medical terminology, office procedures, and HIPAA regulations.
• Communicate insurance changes or trends to appropriate departments.
• Maintain a level of productivity appropriate for the department.
• Appeal insurance/payor denials when applicable.
• Document all communications and contacts in a standardized format.
• Notify department heads of additional staffing or equipment needs.
• Assist with filing and record retrieval as needed.
• Work cooperatively and effectively with staff, physicians, and the public.
• Maintain strict confidentiality of patient medical, personal, and financial information.
• Follow corporate compliance policies and procedures.
• Perform additional duties as assigned by the supervisor.

• Excellent verbal and written communication skills.
• Proficiency with computers and Microsoft Excel, Word, and Windows.
• Strong organizational skills and ability to interpret data.
• Strong judgment, tact, diplomacy, and problem-solving skills.
• Ability to work collaboratively in a team environment.
• Strong attention to confidentiality of hospital and patient information.
• Ability to perform repetitive tasks with minimal independent judgment.
• Familiarity with state and federal confidentiality laws, including HIPAA, and the ability to follow policies regarding the privacy and security of health information.

• Sedentary work involving periods of sitting, talking, typing, and listening.
• Repetitive use of hands, arms, and eyes, which may cause strain.
• Significant manual dexterity required to operate business office machines and equipment.

Job Requirements

• High school diploma required.
• Prior customer service experience in a medical setting preferred.
• Knowledge of medical terminology preferred.
• Previous experience with Microsoft Excel, Word, and Windows.

Comprehensive Benefit Package

• Health Insurance: Co-pay or HSA plan options; 100% paid for employee.
• Dental Insurance: 100% paid for employee.
• Vision Insurance: 100% paid for employee.
• Group Life Insurance: $50,000 with AD&D.
• Long-Term Disability: 100% paid for employee.
• Flexible Spending Accounts: Medical and dependent care options.
• Health Savings Account: Includes employer contribution.
• Supplemental Insurance: Short-Term Disability, Supplemental Life and AD&D, Critical Illness, Hospital Indemnity, and Accident.
• Retirement Plan: 457 plan with Pre-Tax and Roth options.

Why Cherry County Hospital?

• Be part of a dedicated and compassionate healthcare team.
• Enjoy competitive pay and excellent benefits.
• Work in a collaborative and supportive environment.
• Make a meaningful contribution to healthcare in our community.

Join our team at Cherry County Hospital and help us provide exceptional healthcare services to our community.

• High school diploma required
• Prior customer service experience in a medical setting preferred
• Knowledge of medical terminology preferred
• Previous experience with Microsoft Excel, Word, and Windows