The Prior Authorization Specialist serves as a liaison between patients, providers, specialists, and healthcare teams to facilitate timely access to services and promote a positive patient experience.
Essential Duties and Responsibilities- Receive, process, schedule, and follow up on referrals for diagnostic testing, specialists, and other healthcare services.
- Obtain and process prior authorizations and required documentation.
- Maintain accurate referral logs and patient records.
- Coordinate appointments and communicate with patients, providers, and specialists.
- Answer phones, emails, and faxes in a timely and professional manner.
- Review referrals for completeness and accuracy, ensuring all necessary coding, physician notes, and supporting documentation are included.
- Enter patient information into electronic medical records and other required systems.
- Share patient information with referring specialists in accordance with HIPAA guidelines.
- Maintain current knowledge of ICD-10 and CPT coding practices.
- Collaborate effectively with providers and other departments to support quality patient care.
- Comply with all organizational policies, regulatory requirements, and ethical business practices.
- High school diploma or equivalent.
- Excellent verbal and written communication skills.
- Strong organizational, analytical, and problem-solving abilities.
- Ability to manage multiple priorities in a fast-paced environment.
- Proficiency with Microsoft Office and computer systems.
- Associate degree in Medical Office Administration or a related field preferred.
- One or more years of experience in healthcare or a related field.
- Knowledge of ICD-10 and CPT coding.
- Prolonged periods of sitting and working at a computer.
- Ability to lift up to 25 pounds as needed.
At Boone Memorial Health, we are committed to providing exceptional care to our patients and community. We value teamwork, professionalism, and service excellence and strive to create a supportive environment where employees can grow and succeed.
Boone Memorial Health is an equal opportunity employer and is committed to creating an inclusive workplace for all employees and applicants.
Skills Required
- High school diploma or equivalent
- Excellent verbal and written communication skills
- Strong organizational, analytical, and problem-solving abilities
- Ability to manage multiple priorities in a fast-paced environment
- Proficiency with Microsoft Office and computer systems
- Associate degree in Medical Office Administration or a related field
- One or more years of experience in healthcare or a related field
- Knowledge of ICD-10 and CPT coding
- Knowledge of HIPAA and regulatory compliance
- Ability to lift up to 25 pounds as needed
What We Do
Boone Memorial Health is a 501(c)(3) nonprofit healthcare system based in Madison, West Virginia. It primarily serves patients across Boone, Lincoln, Logan, and southern Kanawha counties, operating a critical access hospital with a 25-bed inpatient unit, Level IV Trauma Center, and Black Lung Center, as well as rural health clinics and a substance and mental health treatment program.
