Prior Authorization Clerk

Trego County Lemke Memorial Hospital - H.I.M. is seeking a Full-time Prior Authorization Clerk

PRIOR AUTHORIZATION CLERK

· Full-time position available - 40 hours per week

Position Overview

The individual will be responsible for verifying eligibility and obtaining insurance benefits, ensuring precertification/ authorization and referral requirements are met before delivery of outpatient and ancillary services, and working with providers and nursing staff in the authorization process.

RESPONSIBILITIES

· Reviewing patient medical records, insurance benefits, and eligibility to confirm coverage for requested services.

· Completing and submitting accurate prior authorization forms to insurance companies, including relevant clinical information and supporting documentation.

· Contacting healthcare providers to gather additional information needed for prior authorization requests and following up with insurance companies regarding approval status.

· Understanding medical necessity criteria and collaborating with clinical reviewers to ensure appropriate authorization decisions.

· Identifying and resolving potential issues with prior authorization denials, including appeals and re-submissions.

· Maintaining accurate records of prior authorization requests within the electronic health record system, tracking progress, and monitoring deadlines.

· Staying updated on insurance plan guidelines, regulatory requirements, and industry standards related to prior authorization processes.

· Accepts other duties as assigned.

QUALIFICATIONS & SKILLS

· High School graduate or equivalent.

· Two years of clinical or medical office/billing experience is preferred.

· Computer experience required.

· Understanding of insurance payers and authorizations.

· Strong understanding of medical terminology and healthcare billing codes.

· Ability to effectively communicate in verbal, nonverbal, and written forms; proficient in English language.

· Ability to deal with a variety of personalities/situations that require tact, judgment, and poise.

· Must be able to maintain confidentiality.

· Detail-oriented with strong organizational skills to manage multiple tasks efficiently.

INSTRUCTIONS ON HOW TO APPLY:

Our application must be completed to be considered for this position. Please send application, resume, education, licensure/certifications (if applicable) to Human Resources, 320 N. 13th St., WaKeeney, KS 67672. They may also be dropped off at the hospital business office, emailed to hr@tclmh.org or faxed to (785) 743-6317. To request an application by mail or email, please email or call (785) 743-2182. Applications also available on our website: www.tclmh.org

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Salary commensurate with education and experience. We offer a negotiable nationally competitive salary and excellent benefits.

We are a progressive CAH hospital with in-patient, swing bed, out-patient, home health, assisted living, long-term care, and clinic services.

Candidates must be energetic, possess strong leadership skills, willing to work as a team, have a positive attitude, friendly and compassionate toward patients.

For hospital information: www.tclmh.org

For community information: www.tregocountyks.com

TCLMH is an Equal Opportunity Provider/Employer (EOE) and a tobacco free campus

Job Type: Full-time

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person