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Prior Authorization Specialist
2 months ago
Montrose Regional Health is a leading healthcare provider in the Uncompahgre Valley, offering personalized and professional healthcare services backed by the latest technology and expertise. As a not-for-profit hospital, we are committed to delivering high-quality care to our patients and communities.
About the CareerThe Prior Authorization Specialist plays a critical role in facilitating the process of securing payer authorization for medical services, ensuring timely access to healthcare diagnostics and treatments. This position requires strong communication and negotiation skills, as well as a thorough understanding of health plan benefits and coverage restrictions.
Key Responsibilities- Advocate for patients' medical needs and financial health by facilitating the prior authorization process.
- Support providers in securing payer authorization for medical services, minimizing interruptions to ongoing treatments.
- Review health plan benefits and coverage restrictions to minimize patients' financial risk.
- Interpret clinical documentation for medical necessity requirements and facilitate appeals for coverage denials.
- Prioritize workflow to meet deadlines and ensure efficient processing of prior authorization requests.
- High school diploma or equivalent required; prior authorization experience preferred.
- Ability to achieve minimum level of core competencies and knowledge of procedure authorizations.
- Basic understanding of human anatomy and medical terminology.
- Strong analytical and problem-solving skills, with ability to prioritize and manage multiple tasks.
- Excellent communication and negotiation skills, with ability to work effectively with providers, payers, and patients.
- Competitive salary and benefits package.
- Opportunities for professional growth and development.
- Collaborative and supportive work environment.
- Recognition and rewards for outstanding performance.
- Integrity and honesty in everything we do.
- Service with care and compassion.
- Excellence in all aspects of our work.
- Leadership with innovation and creativity.
