What are the responsibilities and job description for the CLINIC PRIOR AUTHORIZATION SPECIALIST- FT position at Memorial Regional Health?
Essential Functions and Basic Duties
Position Specific Performance Expectations:
o Obtains prior authorizations/pre-certification per payer requirements for physician ordered procedures and
ensures authorization information is documented appropriately in the system.
o Verifies physician orders, authorization and demographic information are all complete prior to sending to
the hospital scheduling department.
o Communication is maintained with providers, clinical staff and patients in relationship to authorization
status.
o Works and assists the billing department in researching and resolving rejected, incorrectly paid and denied
claims as requested
o Remains current with insurance requirements for prior authorization’s and provides education within the
department and clinical staff on changes.
o Maintain efficient tracking of all pending authorizations to ensure timely resolution.
o Performs other duties as assigned.
Organization Wide Performance Expectations:
o Demonstrates commitment to performing according to the CHOICE values of MRH and representing the
organization in a positive and professional manner.
o Maintains patient confidentiality at all times.
o Upholds regulatory requirements to ensure continual compliance with departmental, hospital, state and
federal regulations and policies.
o Follows all policies and procedures to ensure a safe environment for patients, public and staff.
o Completes annual education, training, in-service, and licensure/certification requirements; attends
departmental and organizational staff meetings or reads meeting minutes.
o Reports to work on time and as scheduled; completes work within designated timeframes.
o Establishes and maintains effective verbal and written communication and good working relationships with
all patients, staff and vendors.
o Utilizes initiative; strives to maintain steady level of productivity; self-motivated; manages activity and
time.
o Actively participates in departmental and facility performance improvement and continuous quality
initiatives
Qualifications
Minimum Requirements:
o Must be at least 16 years of age (21 for driving positions)
o Must be able to legally work in the United States
o Must be able to pass a background check
o Must be able to pass a drug screen and breath alcohol test (if applicable)
o Must complete employee health meeting
Education/Licensure/Certification:
o High School Diploma or equivalent preferred
Knowledge Preferred:
o Past knowledge of CPT, HCPCS and ICD-10 codes
o Past knowledge of Medical Terminology
Experience:
o Past experience in the prior authorization process
o Past experience with Microsoft Office to include Word, Excel and Power Point helpful
o Data entry experience
Skills/Abilities:
o Detailed oriented
o To be flexible and able to multi task.
o Bilingual Optional
Position Classification: Non-exempt
Compensation Range: $20.96 to $30.39
Benefits: Medical, Dental, Life, Retirement, Paid Time Off
Salary : $21 - $30
