Prior Authorization Specialist
Job Description Summary
At Logan Health , we're more than just a healthcare provider – we’re a community. Nestled in the heart of Montana, we are committed to delivering exceptional care to our patients while fostering a supportive and collaborative work environment for our team. As a member of Logan Health , you'll be part of a dynamic team that values compassion, innovation, and excellence. We offer opportunities for growth, comprehensive benefits, and a chance to make a meaningful impact in the lives of those we serve. Come join us and experience the Logan Health difference, where your passion meets purpose in a place, you’ll be proud to call home.
Our Mission : Quality, compassionate care for all.
Our Vision : Reimagine health care through connection, service and innovation.
Our Core Values : Be Kind | Trust and Be Trusted | Work Together | Strive for Excellence.
Join Our Prior Authorization Team at Logan Health !
Location: Remote (see approved states)
Schedule: Variable Shift – 8 Hours | Full-Time – 40 Hours
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:
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Obtain prior authorizations for facility and professional charges following departmental protocols.
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Submit CPT and HCPCS codes and medical records to insurers to expedite authorizations.
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Verify patient demographics and medical details, ensuring HIPAA compliance.
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Review and confirm all supporting documents and collaborate with necessary stakeholders.
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Prioritize authorization requests and ensure the accuracy of CPT and ICD-10 codes.
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Maintain intranet resources related to payer requirements for prior authorizations.
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Notify patients or clinics if authorization is not secured before service dates.
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Handle retro authorizations, resolve denials, and manage appeals as needed.
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Track all actions and update patient accounts accurately.
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Communicate issues like billing concerns, backlogs, and documentation needs to leadership.
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Adapt to changing circumstances to support patient flow.
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Maintain professionalism, integrity, and confidentiality in all interactions.
Basic Qualifications:
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2+ years of experience in a hospital, specialty clinic, or medical billing setting focused on pre-certifications or prior authorizations.
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Knowledge of commercial and government insurance requirements, ICD-9/CPT codes, medical terminology, and HIPAA regulations.
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Familiarity with Microsoft Office and willingness to learn new software.
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Strong English communication skills, both written and verbal.
Preferred Qualifications:
- Associate or Bachelor’s degree.
- Experience with Meditech.
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Knowledge of managed care coverage, medical coding, and reimbursement procedures.
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Strong organizational skills, attention to detail, and task prioritization.
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Ability to work independently and as part of a team.
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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:
- Arizona
- Arkansas
- Colorado
- Florida
- Hawaii
- Idaho
- Illinois
- Indiana
- Kansas
- Michigan
- Missouri
- Montana
- Minnesota
- North Carolina
- Ohio
- Oregon
- Tennessee
- Texas
- Virginia
- Washington
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Qualifications:
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Minimum of two (2) years’ experience in an acute care hosp