Health Info Services - Preauthorization Specialist - Part-Time

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Wayne Health Care, Greenville, OH, US

4 days ago Requisition

Position:

The Preauthorization Specialist is a first shift, part-time, 32 hours weekly with no weekend requirements. This position is responsible for securing timely and accurate prior authorizations for outpatient pain management procedures and verifying authorization requirements for both inpatient and outpatient surgeries. This role supports patient access, reduces financial risk, and prevents delays or cancellations by ensuring all required approvals are obtained before services are scheduled or performed.

The specialist works closely with providers, scheduling, surgery, pain management, outside payers, and internal revenue cycle teams to validate coverage, meet payer guidelines, and document all authorization activity.

Qualifications:

• High school diploma or equivalent required
• Certified Medical Assistant preferred
• Clinical background preferred.
• Experience with prior authorization, insurance verification, or revenue cycle preferred.
• Working knowledge of medical terminology, CPT/HCPCS and ICD-10 coding concepts, and payer authorization rules strongly preferred
• Proficiency in EHR and scheduling systems (Epic experience preferred)

Skill and Ability:

• Follow HIPAA, payer rules, hospital policies, and regulatory requirements at all times.
• Demonstrates required job skills, competencies, and safety practices.
• Communicates effectively with patients, providers, families, and coworkers using positive language.
• Thinks critically, works independently, and stays self-motivated.
• Supports coworkers and communicates professionally with internal and external customers.
• Knowledgeable in payer reimbursement, denials, and appeals.
• Obtains and tracks prior authorizations for pain management procedures and ensures medical necessity.
• Validates surgery authorization requirements and ensures accurate CPT/HCPCS and clinical documentation.
• Collaborates with clinical teams to secure missing information and prevent authorization-related denials.
• All other assigned task and responsibilities