Prior Authorizations Specialist at Bryan Health – Kearney, Nebraska

Responsible for obtaining insurance approval for medical services before they are provided. Reviews patient information, verifies insurance coverage, and submits prior authorization requests to insurance companies, ensuring that services are covered and claims will be paid. Tracks the status of authorizations and follows up with insurance companies as needed.

1. *Commits to the KRMC mission, vision, values and goals and consistently demonstrates our core values.

2. *Analyzes patient charts, medical history, and referral information to determine the need for prior authorizations.

3. *Checks patient eligibility and benefits with insurance providers to confirm coverage for specific services or procedures.

4. *Prepares and submits detailed requests to insurance companies, including necessary documentation like clinical notes and supporting information.

5. *Monitors the progress of authorization requests, follows up with insurance companies on pending requests, and escalates issues as needed.

6. *Collaborates with physicians, nurses, and other healthcare professionals to gather necessary information, resolve authorization issues, and inform patients of authorization status.

7. *Maintains accurate records of authorization requests, approvals, denials, and other relevant information in the patient's medical record.

8. *Addresses and resolves any issues or challenges that arise during the authorization process, such as denials or appeals.

9. *Ensures the privacy and security of patient information in accordance with HIPAA regulations.

10. Compiles, organizes, and processes information for the department.

11. Performs monthly inventory counts of medication samples.

12. Assists clinics with the scheduling of Drug Representatives.

11. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

12. Participates in meetings, committees and department projects as assigned.

13. Performs other related projects and duties as assigned.

EDUCATION AND EXPERIENCE:

High school diploma or equivalency required. Associates degree preferred. Prior experience in a medical office setting or with medical billing and coding preferred. Must be 19 years of age to witness legal consents.