Prior Authorization Specialist | Oncology & Hematology Infusion | PRN

Key Responsibilities

• Obtain prior authorizations for facility and professional charges following departmental protocols.
• Submit CPT and HCPCS codes and medical records to insurers to expedite authorizations.
• Verify patient demographics and medical details, ensuring HIPAA compliance.
• Review and confirm all supporting documents and collaborate with necessary stakeholders.
• Prioritize authorization requests and ensure the accuracy of CPT and ICD-10 codes.
• Maintain intranet resources related to payer requirements for prior authorizations.
• Notify patients or clinics if authorization is not secured before service dates.
• Handle retro authorizations, resolve denials, and manage appeals as needed.
• Track all actions and update patient accounts accurately.
• Communicate issues like billing concerns, backlogs, and documentation needs to leadership.
• Adapt to changing circumstances to support patient flow.
• Maintain professionalism, integrity, and confidentiality in all interactions.

Basic Qualifications

• 2+ years of experience in a hospital, specialty clinic, or medical billing setting focused on pre-certifications or prior authorizations.
• Knowledge of commercial and government insurance requirements, ICD-9/CPT codes, medical terminology, and HIPAA regulations.
• Familiarity with Microsoft Office and willingness to learn new software.
• Strong English communication skills, both written and verbal.

Preferred Qualifications

• Associate or Bachelor's degree.
• Experience with Meditech.
• Knowledge of managed care coverage, medical coding, and reimbursement procedures.
• Strong organizational skills, attention to detail, and task prioritization.
• Ability to work independently and as part of a team.
• Excellent interpersonal skills to handle confidential information professionally.

• Maintains regular and consistent attendance as scheduled by department leadership.
• Shift: Day Shift - 8 Hours (United States of America)
• Schedule: PRN - 8 hour shifts, M-F as needed.
• Logan Health operates 24 hours per day, seven days per week. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.

PRN positions (also referred to as Casual, As Needed, or Per Diem) at Logan Health offer flexibility and are designed to provide coverage during busy periods, employee absences, and vacations, making them an excellent opportunity to support the team as needed. PRN employees can participate in a matching 401(k) plan and have access to the Employee Assistance Program. Additionally, they may qualify for hourly differential pay for certain shifts or hours, offering extra compensation based on department-specific scheduling needs. Pay rates and scheduling practices may vary by department.

Notice of Pre-Employment Screening Requirements

If you receive a job offer, please note all offers are contingent upon passing a pre-employment screening, which includes:

• Criminal background check
• Reference checks
• Drug Screening
• Health and Immunizations Screening
• Physical Demand Review/Screening