Prior Authorization Specialist

Job Description

Job Description

Evergreen Health

At Evergreen, we value collaborative, down-to-earth individuals and encourage self-expression. We recognize that our diverse workforce allows us to provide culturally competent care to everyone in our community.

The Prior Authorization Specialist is responsible for managing insurance authorizations, including obtaining and tracking prior authorizations for patients of Primary and Specialty Care Services. They collaborate and support team members to ensure a patient-focused approach to care

As part of the essential functions of this role, the Prior Authorization Specialist :

• Obtains and tracks insurance authorizations for patient care, ensuring timely and accurate processing
• Communicates with insurance companies and payers to verify benefits and resolve any authorization issues
• Collaborates with clinical and administrative staff to ensure seamless patient scheduling and care coordination
• Maintains accurate records of authorization requests, approvals, and denials
• Assists in identifying opportunities to improve authorization workflows and reduce administrative burden
• Assists with paperwork and durable medical equipment (DME) as needed
• Collaborates and supports team members to ensure a patient-focused approach to care
• Delivers excellent customer service to provide positive patient experience across the organization
• Accesses and retrieves medical records via HEALTHeLINK™
• Actively strives to improve patient service delivery through participation in QI / QA activities; attends and participates in all in-services and educational conferences provided by staff and outside vendors

Qualified Candidate will have a High school diploma or equivalent, Associate degree preferred; knowledge of insurance and medical terminology; one (1) year of experience in a healthcare practice preferred; candidate must t be able to communicate clearly and professionally in writing and verbally, demonstrate familiarity with computers and MS Office software (Outlook, Word) and ability to multitask and work effectively in a high-stress and fast-moving environment. Excellent customer service skills required; awareness of and sensitivity to the issues and health disparities faced by underserved populations is essential

Job Type : Full-time

Education : High School Diploma or equivalent required, Associate degree preferred

Experience : Experience and knowledge of insurance and medical terminology required; at least one (1) year experience working in a healthcare facility preferred

What Evergreen Health Offers You :