Job Title: Pre-Authorization Specialist

Location: Scotland Health Care System

Job Description:

Scotland Memorial is seeking a dedicated and detail-oriented Pre-Authorization Specialist to join our team. The Pre-Authorization Specialist will be responsible for ensuring that diagnostic tests performed at Scotland Memorial for scheduled services are authorized in accordance with specific payer-provider requirements. This role is crucial in maintaining compliance and ensuring that patients receive timely and appropriate care.

Key Responsibilities:

• Uses benefits and order information on file to initiate and secure pre-authorizations in advance of the scheduled date of service.

• Communicates with physicians, patients, and payers to secure and/or provide missing demographic, insurance, and/or clinical information to authorize service(s).

• Communicates with the Clinical Lead as needed on additional requirements to obtain the authorization.

• Documents all communications thoroughly, including payer decisions, in a timely manner.

• Identifies patients who may need Medicare Advance Beneficiary Notices (ABNs) and communicates with providers according to internal guidelines.

• Maintains a level of productivity suitable for the department.

• Maintains the Denial Goals for the Division.

• Provides backup coverage for OP Registration if there is a critical need as requested by Patient Access Manager or Director of PFS.

• Attends Revenue Cycle Academy as scheduled.

• Performs other duties as assigned.

Qualifications:

• High school diploma or equivalent; additional education or certification in healthcare administration is preferred.

• Previous experience in a healthcare setting, particularly in pre-authorization or insurance verification, is highly desirable.

• Familiarity with payer policies, NCD, LCD ( preferred)

• Familiarity with Epic EHR (preferred)

• Strong attention to detail and organizational skills.

• Strong Time Management and prioritization skills

• Excellent communication and interpersonal skills.

• Ability to work independently and as part of a team.

• Proficiency in using healthcare management software and tools.

Benefits:

• Competitive salary

• Health, dental, and vision insurance

• Retirement plan

• Paid time off

• Opportunities for professional development and growth

• New in 2025 - Paid Parental Leave!