Prior Authorization Specialist

Prior Authorization Specialist

BMH Forester Building - Revenue Cycle - Madison, WV 25130

Overview

Position Type Full Time

Description

Boone Memorial Health is seeking a detail-oriented and organized Prior Authorization Specialist to join our Referral Department. This position plays a critical role in supporting patient care by coordinating referrals, obtaining prior authorizations, scheduling appointments, and ensuring all required documentation is complete and accurate.

The Prior Authorization Specialist serves as a liaison between patients, providers, specialists, and healthcare teams to facilitate timely access to services and promote a positive patient experience.

Essential Duties and Responsibilities

• Receive, process, schedule, and follow up on referrals for diagnostic testing, specialists, and other healthcare services.
• Obtain and process prior authorizations and required documentation.
• Maintain accurate referral logs and patient records.
• Coordinate appointments and communicate with patients, providers, and specialists.
• Answer phones, emails, and faxes in a timely and professional manner.
• Review referrals for completeness and accuracy, ensuring all necessary coding, physician notes, and supporting documentation are included.
• Enter patient information into electronic medical records and other required systems.
• Share patient information with referring specialists in accordance with HIPAA guidelines.
• Maintain current knowledge of ICD-10 and CPT coding practices.
• Collaborate effectively with providers and other departments to support quality patient care.
• Comply with all organizational policies, regulatory requirements, and ethical business practices.

Qualifications

• High school diploma or equivalent.
• Excellent verbal and written communication skills.
• Strong organizational, analytical, and problem-solving abilities.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency with Microsoft Office and computer systems.
• Associate degree in Medical Office Administration or a related field preferred.
• One or more years of experience in healthcare or a related field.
• Knowledge of ICD-10 and CPT coding.

Physical Requirements

• Prolonged periods of sitting and working at a computer.
• Ability to lift up to 25 pounds as needed.

Why Join Boone Memorial Health?

At Boone Memorial Health, we are committed to providing exceptional care to our patients and community. We value teamwork, professionalism, and service excellence and strive to create a supportive environment where employees can grow and succeed.

Boone Memorial Health is an equal opportunity employer and is committed to creating an inclusive workplace for all employees and applicants.