Authorization Specialist

This is not a remote or hybrid role; on-site presence is required.

JOB SUMMARY:

The Authorization Specialist is responsible for obtaining prior authorizations and verifying insurance coverage for medical procedures, tests, and treatments. This role ensures that all services requiring pre-approval are appropriately documented and authorized before delivery, helping healthcare providers in the hospital and clinic areas secure payment and avoid claim denials.

ESSENTIAL DUTIES:

• Insurance Verification:
  • Verify patient insurance eligibility and benefits for specific procedures and services.
  • Communicate with insurance companies to confirm coverage and requirements.
• Prior Authorization:
  • Submit prior authorization requests for medical services, diagnostic tests, surgeries, medications, and referrals.
  • Monitor and follow up on pending authorizations to ensure timely processing.
• Patient & Provider Communication:
  • Notify patients and clinical staff of authorization status and any additional requirements.
  • Serve as a liaison between the healthcare provider and insurance companies.
• Documentation & Recordkeeping:
  • Accurately document all authorization activities in the Electronic Health Record (EHR) system.
  • Maintain up-to-date records of authorization approvals, denials, and appeals.
• Compliance & Policy Adherence:
  • Stay informed of changing insurance regulations, payer guidelines, and HIPAA requirements.
  • Ensure compliance with all internal and external policies and procedures.

*In addition to the responsibilities described above, the role may include other responsibilities and duties as assigned on occasion, based upon MMH needs or requirements.

COMPETENCIES:

• Support MMH vision and mission.
• Maintain confidentiality of all work information.
• Demonstrate an ability to function successfully in a team environment.
• Exhibit courteous, compassionate, and respectful treatment of internal and external customers.
• Displays a positive attitude and flexibility in changing situations.
• Participates in identifying problems and suggesting solutions.
• Report any compliance issues as designated in the MMH Compliance Program

QUALIFICATIONS:
        MINIMUM:

• High School diploma or equivalent; Associate’s degree in healthcare administration or related field preferred.
• 1–3 years of experience in a healthcare setting, preferably in medical billing, insurance verification, or authorizations.
• Knowledge of medical terminology, CPT/ICD-10 codes, and healthcare insurance processes.
• Familiarity with EHR systems (e.g., Epic, Cerner, Athenahealth) and payer portals.
• Excellent communication, organization, and customer service skills.
• Strong attention to detail and ability to manage multiple priorities.

       PREFERRED:

• Certification in medical billing or coding (e.g., CPC, CCS, or CMRS).
• Experience with government and commercial insurance payers (e.g., Medicare, Medicaid, BCBS, Aetna).
• Bilingual (Spanish/English) preferred in some settings

"This position will remain open until filled; however, applications will be reviewed on a rolling basis."

WHY WORK AT MELISSA MEMORIAL HOSPITAL? 

At Melissa Memorial Hospital, we’re a family not just a healthcare provider serving patients, staff, and community with care and inclusion. Here’s why you’ll thrive here:

• Core Values: Integrity, Passion, Service, Collaboration, Ownership, Courage drive us.
• Mission: “Compassionate care, nurturing trust.”, Tagline: “Seek Health. Live Well.”
• Eastern Plains Heart: A tight-knit team delivering impactful care.
• Balance: Work-life support plus the tools to excel in your current role and help you grow!

WHAT WE OFFER: 

• 100% Employer paid Medical (Employee Only) 
• Dental and Vision insurance 
• Retirement Plans, with up to 3% employer match 
• Voluntary Group Benefits 
• Employee Assistance Program 
• Gym Membership Discount 
• PTO, Paid Sick Time 
• Continuing Education Benefits 
• FSA 
• MASA Insurance 
• Eligibility for Student Loan Repayment  

MELISSA MEMORIAL HOSPITAL: 

Melissa Memorial Hospital is a 15-bed critical access hospital, located in Holyoke, Colorado. While being “rural” we are equipped for any situation. It is a model rural hospital with 1 operating room, surgical procedure room, 4 bay emergency room, and radiology including 64-slice CT scanner and mammography, MRI, ECHO, and Nuclear Medicine, along with other ancillary services. The hospital is co-located with a family practice clinic and retail pharmacy services. Other services include chemotherapy, general & orthopedic surgery, podiatry, cardiology, orthopedic surgery, progressive rehab services, and wound care. MMH operates a full-time EMS service and maintains a 24/7 AirLife Helicopter base. 

THE COMMUNITY: 

Holyoke is home to the Holyoke Dragons and is truly a “City of Pride and Progress.” Holyoke offers: 

From different coffee shops to different ethnic flavors, to a quick bite, the sweet small town of Holyoke has a handful of different restaurant options to choose from. 

Holyoke is based in Phillips County where there are four different rural towns in the county with two schools in the county. Holyoke, Amherst. Paoli, and Haxtun are all within the same county. Holyoke homes a historical museum with different artifacts of what has built Holyoke today. You will see the fields turn different colors throughout different seasons. Your wheat, corn, alfalfa, are some of the few cultivating growths that you will see around your area! If you enjoy hunting, there are plenty of opportunities for a good catch. You will discover that you can see the most beautiful sunsets and the clearest starry nights out in the rural areas. Come take a look at our beautiful little town in the Northeastern corner of Colorado. 

Click here for a List of Things to Do in Holyoke 

Melissa Memorial Hospital is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Salary : $18 - $27