Prior Authorization Specialist | Patient Access

Job Description Summary:

At Logan Health, we’re more than just healthcare providers—we’re a community. Located in the heart of Montana, we deliver exceptional care to patients while creating a supportive and collaborative work environment for our team. Join us to grow professionally, enjoy comprehensive benefits, and make a meaningful impact in a place you’ll be proud to call home.

Are you passionate about helping patients navigate the financial side of healthcare? We’re looking for a detail-oriented Prior Authorization Specialist to ensure a smooth and efficient process for obtaining prior authorizations for procedural orders.

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.

This position offers full-time remote work.   

To be eligible, you must reside in one of the following states:    

• Arkansas  

• Arizona  

• Colorado  

• Florida  

• Hawaii  

• Idaho  

• Illinois  

• Indiana  

• Kansas  

• Michigan  

• Missouri  

• Montana  

• Minnesota  

• New Mexico  

• North Carolina  

• Ohio  

• Oregon  

• South Dakota  

• Tennessee  

• Texas  

• Virginia