Prior-Authorization Specialist

Requisition ID
# of Openings
Administrative / Clerical
Pay Period Status
Monday-Friday; 8:00am - 5:00pm


In collaboration with RMHL Leadership, this position ensures smooth operation of the department. A strong focus on insurance verification, pre-authorizations, coordination between departments, and coordination of care with other RMHL clinics. Works closely with RMHL’s front office, scheduling and coding departments to ensure pre-auths for appointments and appropriate episodes attached to billing.   Deals with a diverse group of external callers: physicians, patients, facilities, as well as internal contacts at all levels of the organization. Researches and serves as an office resource for insurance changes, credentialing requirements, and invalid or incorrect patient demographic information


  1. Responsible for insurance verification, pre-authorization, related scheduling of patient appointments including coordination between departments, and coordination of care with other RMHL clinics.
  2. *Educates and communicates with staff regarding changes to insurance and credentialing requirements. Communicates changes, reminders, and updates.
  3. *Researches and corrects invalid or incorrect patient demographic and insurance information.
  4. *Researches and works with office staff in resolving authorization denials as requested. Prepares, submits, and tracks appeals when necessary.
  5. *Deals directly with a variety of departments, physicians, patients, external facilities, as well as internal contacts at all levels of the organization; serving as a liaison during the authorization process.
  6. *Serves as a resource for billing issues, including compliance and appropriateness of coding and billing; uses knowledge and understanding of reimbursement rules and regulations of third party payers and general billing practices.
  7. *Communicates with all providers and provider offices to clarify diagnosis and procedures for appropriate code assignment. Responsible for obtaining documentation amendments as needed.
  8. *Accurately documents patient accounts of all actions taken.
  9. *Informs, educates, and communicates with department management of any billing or authorization concerns, backlogs, insurance issues, problematic accounts, documentation issues, and time available for additional tasks.
  10. *Adapts to changing circumstances, showing flexibility in job function to meet the needs of patient flow. Completes additional related prior authorization projects and duties as assigned.
  11. *Demonstrates written and verbal professionalism at all times when interacting with patients, families, visitors, referring personnel and team members. Ensures all departmental transactions and interactions are completed with integrity, confidentiality, honesty and dignity while valuing and addressing the individual needs of each patient


  1. Minimum of two (2) years’ experience in a medical office, clinic, or other customer service setting preferred. ICD-10 and CPT coding experience preferred. Medical office background with billing and financial management experience preferred.
  2. Excellent telephone and customer service skills required. Computer skills required with experience in Meditech and Microsoft Office preferred. Ability to operate and learn automated systems and other office equipment.
  3. Knowledgeable of the clinical care provided in the office setting along with insurance requirements, filing, back office processes, and medical terminology knowledge and skills, and rules and regulations governing the handling of private health information.
  4. Ability to take initiative, exercise independent judgment and problem-solve; ability to work effectively with staff, patients, public, and external agencies; skills in planning, organizing, delegating and supervising; skills in interpreting data.
  5. Must be able to manage multiple responsibilities in an effective manner, problem solve, work independently, as well as a team member in various settings, and possess excellent organizational skills.
  6. Ability to communicate both verbally and written and interact, with all levels of healthcare professionals and patients in a positive and professional manner. Must be able to employ tack, diplomacy and compassion with all types of people. Ability to understand the mission of the clinic and to implement it into daily activities.


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