Prior Authorization Specialist

Job Description Summary At Logan Health, we're more than just a healthcare provider – we’re a community. Nestled in the heart of Montana, we are committed to delivering exceptional care to our patients while fostering a supportive and collaborative work environment for our team. As a member of Logan Health, you'll be part of a dynamic team that values compassion, innovation, and excellence. We offer opportunities for growth, comprehensive benefits, and a chance to make a meaningful impact in the lives of those we serve. Come join us and experience the Logan Health difference, where your passion meets purpose in a place, you’ll be proud to call home. Our Mission: Quality, compassionate care for all. Our Vision: Reimagine health care through connection, service and innovation. Our Core Values: Be Kind | Trust and Be Trusted | Work Together | Strive for Excellence. Join Our Prior Authorization Team at Logan Health! Location: Remote (see approved states) Schedule: Variable Shift – 8 Hours | Full-Time – 40 Hours 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: ArizonaArkansasColoradoFloridaHawaiiIdahoIllinoisIndianaKansasMichiganMissouriMontanaMinnesotaNorth CarolinaOhioOregonTennesseeTexasVirginiaWashington--- Qualifications: Minimum of two (2) years’ experience in an acute care hospital, specialty clinic and/or medical billing office obtaining pre-certifications and/or prior-authorizations required. Possess knowledge and understanding of commercial and government insurance requirements, medical terminology, and rules and regulations governing the handling of private health information required. Possess a working knowledge and understanding of ICD-9 and CPT codes required. Possess insight and understanding into reimbursement and claims procedures and its direct impact on the revenue cycle required. Possess and maintain computer skills to include working knowledge of Microsoft Office Suite and ability to learn other software as needed. Meditech experience preferred. Excellent verbal and written communication skills including the ability to communicate effectively with various audiences. Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently. Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy. Job Specific Duties: Responsible for obtaining accurate prior authorizations for facility and professional charges related to scheduled patient appointments per department procedure and protocol. Performs timely and accurate submission of CPT, HCPCS codes and medical records to insurance carriers to expedite prior authorization requests. Accurately secures patients’ demographics and medical information and ensures all procedures are in line with HIPAA compliance and regulations. Reviews accuracy and completeness of information requested and ensures all supporting documents are present. Collaborates with stakeholders as appropriate. Prioritizes incoming authorization requests according to department procedure and protocol. Confirms accuracy of CPT and ICD10 diagnoses in the procedure order. Maintains the Logan Health intranet related to payer requirements needed to successfully obtain a prior authorization. Contacts patient and/or clinic to advise if authorization request has not been obtained prior to date of service. Researches and works with appropriate stakeholders in initiating retro authorization requests and resolving authorization denials as needed. Prepares, submits, and tracks appeals as necessary. Accurately documents patient accounts of all actions taken. Informs, educates, and communicates with leadership to include, but may not be limited to; billing or authorization concerns, backlogs, insurance issues, problematic accounts, documentation issues, etc. Adapts to changing circumstances to meet the needs of patient flow. Exhibits written and verbal professionalism at all times when interacting with others. Ensures all departmental transactions and interactions are completed with integrity, confidentiality, and professionalism. The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position. Maintains regular and consistent attendance as scheduled by department leadership. Shift: Variable - 8 Hours (United States of America) Location: Remote (see approved states) Schedule: Variable Shift – 8 Hours | Full-Time – 40 Hours Logan Health operates 24 hours per day, seven days per week. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. Notice of Pre-Employment Screening Requirements If you receive a job offer, please note all offers are contingent upon passing a pre-employment screening, which includes: Criminal background check Reference checks Drug Screening Health and Immunizations Screening Physical Demand Review/Screening 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. At Logan Health, our work is driven by our mission, vision, and values: Our Mission Quality, compassionate care for all. Our Vision Reimagine health care through connection, service, and innovation. Our Core Values Be Kind – We foster compassion and positivity in our work environment. Work Together – Collaboration leads to innovation, efficiency, and improved communication. Trust and Be Trusted – We build trust by acting with authenticity, empathy, and good intent. Strive for Excellence – We continually push ourselves to improve, innovate, and deliver high-quality care and services. #J-18808-Ljbffr Logan Health