Pre-Authorization Specialist

Job Title

This position is responsible for screening prior-authorization and coordination of specialized services requested at Holton Community Hospital, including a broad range of requests for outpatients, ancillary and clinic services. Performs patient pre-registration, insurance verification, identifies prior authorization/notification requirements, finalizes patient financial information, informs the patient/guarantor of all financial liabilities and documents all information into the appropriate system. Communicate with patients, insurance companies and pertinent staff as necessary. Adheres to policies and procedures in order to comply with performance and compliance standards and to ensure cost effective and appropriate healthcare delivery. Maintains current knowledge of network resources for referral and linkage to member's and provider's needs. Authorizes certain specified services according to departmental guidelines.

Requirements

• Must have a High School Diploma
• Associate's degree in Health Information Management, a Coding Certificate, or a technical degree program in healthcare or billing is preferred.

Skills and Abilities

• Basic computer skills required.
• Prior coding experience preferred.
• Experience working in a healthcare or insurance environment, preferably in pre-authorization or medical billing.
• Strong knowledge of medical terminology and insurance processes.
• Proficiency with electronic health records (EHR) systems and insurance portals.
• Excellent communication and organizational skills
• Familiarity with HIPAA regulations and patient privacy standards.
• Experience with specific insurance providers and their authorization procedures.
• Ability to analyze and resolve complex insurance denials.

Benefits

We offer a complete, comprehensive benefit package that includes:

• Health
• Dental
• Vision
• Life
• Retirement Savings with Employer Match
• Health Savings Accounts, with Employer Match
• Flexible Spending Accounts, Medical & Dependent Care
• Supplemental Coverages including Short Term & Long Term Disability, Accident, Hospital Confinement, Cancer
• Paid Time Off
• Employee Assistance Program
• And most importantly, we offer a flexible work environment that supports a healthy work-home life balance.