Revenue Cycle Pre-Authorization Specialist

This position is responsible for obtaining prior authorizations for all scheduled/ordered services for hospital locations including Centra Central Virginia Imaging. Essential duties include obtaining prior authorizations and ensuring accurate demographic and insurance information is entered into applicable systems for scheduled services. Acts as a liaison for providers requesting hospital services at Centra Health requiring a prior authorization.

Required Qualifications:

High school diploma or equivalent

Proficient with Microsoft Office Products

Proficient typing and spelling

Proficient computer skills, multitasking with data entry while using multiple computer applications

Ability to provide high level of customer service, attention to detail, critical thinking, and have proficient written and verbal communication skills

Ability to work independently and maintain productivity.

Preferred Qualifications:

Some college experience in healthcare, business, accounting and/or professional certification preferred. Associates degree and/or bachelor’s degree in medical preferred

Prior Revenue Cycle experience in a healthcare setting

Prior authorization experience in a healthcare setting

Knowledge of ICD-10 and CPT codes as well as other medical terminology

Knowledge of insurance plans

Have an understanding and ability to communicate financial and insurance information

Salary Range: $19.32- $28.01 / Hour

Essential Duties and Responsibilities:

• Communicates with insurance companies to obtain prior authorizations for surgeries, imaging studies, cardiology testing, surgical procedures, Interventional testing/procedures and other scheduled services
• Verifies insurance eligibility and benefit information and updates EMR as appropriate
• Initiates timely prior authorization requests with insurance plans either by phone or the payer portal
• Submits medical documentation needed to obtain prior authorizations
• Requests medical records, updated orders, and insurance information from non-CMG providers when appropriate .
• Requests additional information as appropriate from CMG providers.
• Monitors all worklists for urgent scheduling add-ons to secure prior authorizations
• Coordinates peer-to-peer requests with insurance plans and the ordering providers
• Demonstrates persistence when obtaining authorization status from insurance carriers
• Updates the patient accounting system with authorization numbers for specified services and date spans
• Notifies Scheduling/Registration and ordering providers of any delays or rescheduling needs due to payer delays
• Understands payer policies related to authorization requirements and timeframes needed to obtain authorizations
• Appropriately respond to phone calls, emails, Teams messages, and other forms of communication.
Complies with governmental regulations in reference to healthcare, billing, the Health Insurance Portability and Accountability Act (HIPAA), The Joint Commission (TJC) standards, Centers for Medicare and Medicaid Services (CMS), Emergency Medical Treatment and Labor Act (EMTALA), as well as Centra and Acute Revenue Cycle department policies and procedures.

Other Functions:

Provides courteous service to all stakeholders (patients, patient families, teammates, other department staff, etc.) by resolving stakeholder problems, responding to inquiries, and following up to develop and strengthen customer relationships.

Cover other shifts and departments as needed within Acute Revenue Cycle Departments.

Assist in training of new hires as needed.

Perform other duties as assigned or requested and job specifications can be modified or updated at any time.