Medical Prior Authorization Specialist in Creedmoor, North Carolina at Granville Medical Center

Medical Prior Authorization Specialist

Medical Prior Authorization Specialist
Location: Granville Health System, Oxford NC

About Granville Health System:

For over a century, Granville Health System has been at the forefront of quality healthcare. To cater to the evolving needs of its community, Granville Health System has extended its services throughout Granville County, ensuring convenient medical care access for its residents. The Granville Health System main campus can be found at 1010 College Street, Oxford, North Carolina. For more details, visit GHS online at www.ghsHospital.org.

About Oxford, NC

Oxford, NC is a charming and welcoming community that offers a perfect blend of small-town charm and modern convenience, making it an ideal place to live and work. Located just about 30 miles north of Durham and 40 miles from Raleigh. The region enjoys a mild, four-season climate with warm summers, crisp autumns, blooming springs, and gentle winters—perfect for enjoying the area's outdoor activities year-round. With a thriving local economy, excellent healthcare facilities, and a strong sense of community, its historic downtown, scenic parks, and proximity to the Research Triangle ensure a balanced lifestyle with both professional and personal fulfillment.

Position Overview:

Schedule procedures and obtain prior authorization approval for procedures and medications. Appeal prior authorization denial. Assess accounts for completeness and accuracy to obtain authorizations.

Position Highlights:

• Retirement Benefits: NC Local Government Pension Plan (5-year vesting period)
• Loan Forgiveness: Eligible employer for Public Service Loan Forgiveness (PSLF)
• Comprehensive Benefits: Medical, dental, vision, life insurance, and various supplemental benefits available

Key Responsibilities:

Prior Authorizations & Insurance Coordination

Obtain and manage prior authorizations for diagnostic testing, specialty consultations, procedures, medications, durable medical equipment (DME), and other ordered services.

Verify patient insurance eligibility, benefits, and coverage requirements prior to services.

Review payer-specific requirements and ensure authorization requests are submitted accurately and timely.

Monitor authorization status and proactively follow up with insurance carriers to prevent delays in patient care.

Assess accounts for completeness and accuracy to support successful authorization approval.

Communicate authorization requirements, approvals, denials, and status updates to patients, providers, and clinical staff.

Maintain accurate tracking and documentation of authorization activity.

Collaborate with providers and clinical staff to obtain supporting clinical documentation required for authorization requests.

Medication Prior Authorizations & Denials Management

Obtain prior authorization approvals for prescribed medications.

Investigate, track, and appeal authorization denials when appropriate.

Submit supporting documentation, medical necessity information, and required forms to insurance carriers.

Follow up on pending requests and communicate outcomes to patients and clinical staff.

Appeal denials utilizing appropriate clinical documentation, coding information, and payer requirements.

Monitor authorization and denial trends and communicate opportunities for process improvement.

Insurance Verification & Benefits Coordination

Verify patient insurance eligibility and benefits prior to appointments, services, and diagnostic testing.

Maintain accurate and up-to-date insurance information within the electronic medical record.

Identify coverage limitations and notify patients and providers of potential barriers to care.

Serve as a resource to providers and staff regarding payer requirements and insurance guidelines.

Referral Support

Assist with referral coordination and processing as operational needs permit.

Support providers and clinical staff in facilitating referrals to specialists, ancillary providers, imaging centers, therapy services, and other healthcare resources.

Communicate referral-related information to patients and external organizations as needed.

Maintain accurate documentation of referral activity when assigned.

Documentation, Compliance & Administrative Support

Maintain complete, accurate, and timely documentation of all authorization, insurance, and referral-related activities.

Ensure compliance with HIPAA regulations, payer requirements, and organizational policies.

Document account activity and maintain audit-ready records.

Perform additional duties and special projects as assigned by Practice Leadership.

Qualifications:

High School Diploma or GED required.

Minimum of two (2) years of experience in a healthcare setting involving insurance verification, prior authorizations, referrals, revenue cycle operations, patient access, medical office administration, or related responsibilities.

Preferred:

Three (3) or more years of experience managing prior authorizations in primary care, family medicine, internal medicine, or multispecialty clinic environment.

Apply Today:
If you're a dedicated professional looking for a position with a focus on work-life balance and the opportunity to make a difference, we encourage you to apply for this position with Granville Health System.