Prior Authorization Specialist

Georgetown Community Hospital

Who We Are:

People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Georgetown Community Hospital is an acute care hospital with 75‑beds offering a broad range of inpatient, outpatient, intensive care, surgical, emergency and diagnostic services. From our bariatrics to women’s services to radiology, we have a wide range of services serve our community.

Where We Are:

Georgetown is a small town bursting with charm in the midst of Kentucky Horse Country and is the true birthplace of bourbon. We are proud to be Kentucky’s fastest growing city and home to a diverse list of adventures for all including petting a thoroughbred champion, feeling the thunder of a new engine roar to life, and strolling along a bustling Victorian‑era downtown with architectural charm and locally‑owned shops, restaurants, craft breweries and a bourbon distillery.

• Health (Medical, Dental, Vision) and 401K Benefits for full‑time employees
• Competitive Paid Time Off
• Employee Assistance Program – mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• Options for accident, critical illness, long‑term, short‑term, and hospital indemnity insurance
• Professional development opportunities
• Free Parking
• And much more…

Under the general direction of the department director, the Physician Services Surgery Authorization Specialist will primarily be responsible for authorizing medical procedures for prospective patients by coordinating all aspects of the scheduling cycle. This will initially include order intake via phone queue and fax as well as insurance benefit verification. Additionally, the position requires an ability to handle clinical assessment and insurance authorizations that are necessary preconditions for qualifying patients both medically and financially for final appointment confirmation.

This position will also involve a basic understanding of insurance material such as claims, denial resolution, and appeals as needed. This position reflects a “help desk” approach to authorizing by actively responding to the general needs of the ordering physician’s and their patients.

• High School Diploma or equivalent, Preferred
• Associate’s degree, Preferred

• 3-4 years experience in a medical environment (hospital ancillary department, doctor’s office, x-ray lab), preferably with additional exposure to a related field such as registration, claims and patient financial services, or other ancillary department experience, etc.
• A broad employment history in these settings will be most helpful.

• Must possess a working knowledge of commonly used healthcare concepts, practices, and procedures with particular emphasis on Outpatient Services.
• Requires a demonstrated ability to evaluate a patient’s medical history via chart notes or other clinical source and accurately apply it to commercial insurance utilization criteria.
• Must be able to stand, walk, and conduct frequent face‑to‑face encounters with patients and medical staff throughout the hospital for a significant portion of the workday when required.
• Any special knowledge, skills, certification, or training will be particularly valuable (e.g. Bilingual (Spanish/English), coding certificate, prior clinical background, prior managed care employment, etc).
• 1 year in customer service or similar role. Familiar with call center environment preferred

• Requires excellence in customer service and telephone etiquette.
• Must be able to participate in receiving phone calls via a department telephone queue.
• Uses clinical knowledge to receive orders for review and clarification when needed, including medical necessity checking for all Medicare patients.
• Must be able to integrate a variety of clinical data, assess, and conduct medical necessity reviews with appointed utilization review departments. This will include exchanging clinical information with clinic staff and physicians and negotiating the best possible outcome or alternative modality.
• Must show a strong attention to detail…