Prior Authorization Specialist

Join Our Prior Authorization Team At Logan Health! At Logan Health, we're more than just healthcare providers – we're a community. Located in the heart of Montana, we deliver exceptional care to patients while creating a supportive and collaborative work environment for our team. Join us to grow professionally, enjoy comprehensive benefits, and make a meaningful impact in a place you'll be proud to call home. Are you passionate about helping patients navigate the financial side of healthcare? We're looking for a detail-oriented Prior Authorization Specialist to ensure a smooth and efficient process for obtaining prior authorizations for procedural orders. Key Responsibilities: Obtain prior authorizations for facility and professional charges following departmental protocols. Submit CPT and HCPCS codes and medical records to insurers to expedite authorizations. Verify patient demographics and medical details, ensuring HIPAA compliance. Review and confirm all supporting documents and collaborate with necessary stakeholders. Prioritize authorization requests and ensure the accuracy of CPT and ICD-10 codes. Maintain intranet resources related to payer requirements for prior authorizations. Notify patients or clinics if authorization is not secured before service dates. Handle retro authorizations, resolve denials, and manage appeals as needed. Track all actions and update patient accounts accurately. Communicate issues like billing concerns, backlogs, and documentation needs to leadership. Adapt to changing circumstances to support patient flow. Maintain professionalism, integrity, and confidentiality in all interactions. Basic Qualifications: 2+ years of experience in a hospital, specialty clinic, or medical billing setting focused on pre-certifications or prior authorizations. Knowledge of commercial and government insurance requirements, ICD-9/CPT codes, medical terminology, and HIPAA regulations. Familiarity with Microsoft Office and willingness to learn new software. Strong English communication skills, both written and verbal. Preferred Qualifications: Associate or Bachelor's degree. Experience with Meditech. Knowledge of managed care coverage, medical coding, and reimbursement procedures. Strong organizational skills, attention to detail, and task prioritization. Ability to work independently and as part of a team. Excellent interpersonal skills to handle confidential information professionally. This position offers full-time remote work. To be eligible, you must reside in one of the following states: Arizona Arkansas Colorado Florida Hawaii Idaho Illinois Indiana Kansas Michigan Missouri Montana Minnesota North Carolina Ohio Oregon Tennessee Texas Virginia Washington Equal Opportunity Employer Logan Health is an Equal Opportunity Employer (EOE/AA/M-F/Vet/Disability). We encourage all qualified individuals to apply for employment. We do not discriminate against any applicant or employee based on protected veteran status, race, color, gender, sexual orientation, religion, national origin, age, disability or any other basis protected by applicable law. If you require accommodation to complete the application, testing or interview process, please notify Human Resources. Logan Health