PRIOR AUTHORIZATION SPECIALIST | Pain Clinic

Salina Regional Health Center

PRIOR AUTHORIZATION SPECIALIST

POSITION SUMMARY
Responsible for obtaining prior authorizations for procedures, medications, imaging, and treatments across assigned clinics, and other specialty areas. This role ensures timely and accurate processing of authorizations by coordinating with insurance companies, providers, and clinical staff. This role supports patient accesss, reduces delays in care, and ensures compliance with payer guidelines, CMS regulations, and SRHC policies. The role may also provide clerical/administrative support as needed to maintain efficient clinic operations.

POPULATION SERVED: Infant, Child, Adolescent, Adult, Geriatric
OSHA CATEGORY III

ESSENTIAL JOB FUNCTIONS

QUALITY
Initiates, completes, and manages prior authorization requests for procedures, medications, imaging, and treatments, including those specific to assigned clinics.
Reviews clinical documentation and payer requirements to ensure accurate and compliant submission of authorization requests.
Communicates with providers, pharmacists, clinical staff, and insurance companies to gather required information and resolve authorization issues.
Documents all authorization activities, communications, and outcomes in the electronic medical record (EMR) in accordance with regulatory standards.
Maintains current knowledge of payer policies, CMS guidelines, and authorization requirements relevant to assigned clinics.

ACCESS
Ensures timely completion of authorizations to support efficient scheduling and prevent delays in patient care.
Communicates authorization status to providers, schedulers, and patients in a clear and professional manner.
Collaborates with clinic teams to optimize workflow, reduce barriers to care, and support a positive patient experience.

STEWARDSHIP
Tracks pending authorizations, monitors denials, and prepares appeals when appropriate to support financial sustainability and reduce avoidable write offs.
Uses resources responsibly, maintains organized records, and supports accurate billing and documentation processes in alignment with SRHC and payer requirements.

ORGANIZATIONAL VALUES

PATIENT CENTERED
Keeps the welfare of the patient at the center of all decisions and actions by maintaining a customer-centered focus at all times.
Advocates for patients and their families by practicing behaviors that create a culture of patient focused activity.

QUALITY
Expects excellence of self and others.
Questions the status quo; uses creativity and innovation to engage in performance and process improvement.
Identifies and mitigates risk.

INTEGRITY
Is honest and ethical in all matters.
Demonstrates teamwork/cooperation within and across departments, understanding others perspectives and resolving conflict constructively.

TRUST
Safeguards the privacy, security, and confidentiality of protected health information at all times.
Treats all people with dignity; supports diversity; and understands related issues.
Is flexible and adaptable to change; demonstrates a positive and supportive attitude; and willingly accepts change.

SUSTAINABILITY
Holds self and others accountable in the use of SRHC supplies, and completion of tasks in a timely, efficient, and productive manner.
Volunteers for or accepts new or additional duties/responsibilities for the greater good of the department, organization, and/or patient.

POSITION QUALIFICATIONS

MINIMUM EDUCATION
None

MINIMUM EXPERIENCE
None

REQUIRED REGISTRATION/LICENSE/CERTIFICATION
None

PHYSICAL DEMANDS
Lifts, positions, pushes and/or transfers up to 25 pounds
Prolonged, extensive or considerable standing/walking
Considerable reaching, stooping, bending, kneeling, crouching
Manual dexterity and mobility
Near acuity: ability to see clearly at 20 inches or less

WORKING CONDITIONS
Subject to varying and unpredictable situations
Subject to many interruptions; pressure due to multiple calls, inquires, and/or deadlines

EMPLOYEE ACKNOWLEDGEMENT
In signing the job description, I attest that I will adhere to Salina Regional Health Center’s policies, procedures, and regulatory standards, including but not limited to complying fully with the Corporate Compliance Program and Code of Ethical Conduct; and participating actively in the Quality Assessment and Performance Improvement Plan, including identifying and mitigating risk to patients.

I acknowledge that I have read, understand, and accept the qualifications, responsibilities, and performance expectations outlined in the job description. I recognize that these duties form the basis for my performance evaluations, and that management reserves the right to assign additional tasks or change existing essential job functions as operational needs dictate. I confirm that I am able to perform the essential functions of this position with or without reasonable accommodation.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.