What are the responsibilities and job description for the In-Patient Authorization Specialist position at Central Montana Medical Center?
Department Utilization Review Exempt
Immediate Supervisor Utilization Review Coordinator Non-exempt
Supervisor next Chief Nursing Officer Workweek Up to 40
in line
POSITION SUMMARY
Under direct supervision of the Utilization Review Nurse, the primary purpose of the Inpatient Authorization
Specialist is to obtain and manage payer authorizations to support reimbursement and reduce denials for all
inpatient admissions on both Acute Care and OB.
Continued employment and raises in this position are dependent upon ’s fiscal
viability and:
- Actions and communications that contribute to a team concept and create a positive environment for
- Acceptable performance of essential and all job duties
- Acceptable attendance record
- Accountability for safety to self, patients, visitors and all customers, and care of equipment and
- Adherence to departmental and facility policies and procedures, education requirements, compliance
- Accountability for the consequences of own actions
- Physical and emotional ability to perform essential functions
- Acceptable background investigation results if required for position
Minimum Education, Experience, Licensure, Certification required:
• Minimum of 3 years of experience in inpatient authorization, utilization review (UR), case management
- PACS (Prior Authorization Certified Specialist) certification strongly preferred at time of hire or within 1
- Completion of a Utilization Review (UR) Bootcamp or equivalent advanced training required within 6
months of onboarding.
ESSENTIAL FUNCTIONS/DUTIES:
(Must be able to perform with or without accommodation)
1 Prior Authorization for:
- All admissions to Acute Care and OB, when required
- Transfers
- Procedures
- Imaging
- Outpatient Services
- Track authorization expiration dates
- Request additional approved days
- Coordinate with UR nurse for clinical information
- Verify benefits and coverage
- Confirm payer requirements
- Identify authorization needs before services are delivered whenever possible
- Submit clinical records to payers
- Maintain authorization records
- Track reference numbers and approvals
- Monitor authorization-related denials
- Identify trends
- Collaborate with UR nurse and Patient Financial Services
Specialist
6 Appeals Support
- Gather documentation for appeals
- Assist with payer reconsiderations
- Track appeal outcomes
- Authorization turnaround times
- Authorization-related denials
- Approval rates
- Appeal success rates
- Maintain up-to-date knowledge of payer policies, regulatory requirements, and industry best
- Ensure accurate and timely documentation of all authorization activities within the EMR and
- Act as a resource and mentor to team members, promoting best practices and contributing to
- Maintain productivity, quality, and compliance standards in a fast-paced, high volume
environment
9 Collaboration
- Collaborate closely with Utilization Review, Discharge Planning, and Revenue Cycle teams to
- Support onboarding and training efforts, including participation in UR Bootcamp and ongoing
- This position is an in-house role requiring on-site work. Any exception to this requirement,
on operational needs
Knowledge, Skills, Abilities:
• Demonstrates expertise in payer guidelines, medical necessity criteria (e.gl, InterQual, MCG), and
- Proven ability to manage complex, high-volume authorization workflows with a high degree of
- Strong working knowledge of EMR systems, insurance portals, and revenue cycle processes
- Excellent communication and negotiation skills, with demonstrated success in peer-to-peer reviews
- High level of professionalism, organizational skills, and ability to function as a subject matter expert
- Advanced computer skills, including a high degree of proficiency in Microsoft Word, Excel, Teams and
Outlook
OCCUPATIONAL EXPOSURE for this position:
Category I Direct contact with blood or other bodily fluid to which universal
precautions apply
Category II Activity performed without blood/bodily fluids exposure, but
exposure may occur in emergency
Category III Task/activity does not ordinarily entail predictable exposure to
blood/bodily fluids
OTHER EXPOSURE for this position:
Radiation
Noise
Other (Specify) Artificial lighting, minimal windows, variation in room
temperature, extended periods in front of a PC.
PHYSICAL DEMANDS:
Specialist
(Essential functions strength rating for position - see Job Analysis)
Sedentary Exert up to 10# occasionally or negligible force frequently
Light Exert up to 20# occasionally, < 10# frequently or negligible force
constantly
Medium Exert up to 50# occasionally, up to 25# or up to 10# constantly
Heavy Exert up to 100# occasionally, up to 50# frequently or up to 20#
constantly
Very Heavy Exert > 100# occasionally, > 50# frequently or
> 20# constantly