The Pre-Authorization Specialist ensures that scheduled procedures performed at Scotland Memorial are authorized in accordance with specific payer-provider requirements.

Scotland Health Care System is looking for a detail-oriented and dedicated Pre Authorization Specialist to join our team. The ideal candidate will be responsible for managing the pre-authorization process for medical services, ensuring timely and accurate approvals, and maintaining compliance with insurance requirements. This role is essential in facilitating patient access to necessary care and optimizing the revenue cycle.

Key Responsibilities:

• Review and process pre-authorization requests for medical services.
• Communicate with healthcare providers, insurance companies, and patients to obtain necessary information and resolve authorization issues.
• Ensure compliance with insurance requirements and regulatory guidelines.
• Maintain accurate and up-to-date records of pre-authorization requests and approvals.
• Monitor and analyze pre-authorization metrics to identify areas for improvement.
• Provide support and education to healthcare providers and staff on pre-authorization processes and requirements.
• Assist in the development and implementation of policies and procedures related to pre-authorization.

Qualifications:

• High School Diploma or Equivalent Required, Associate's or Bachelor's degree in healthcare administration, business, or a related field, preferred.
• 2 years of experience in pre-authorization, medical billing, or a related field, preferred.
• Strong knowledge of insurance requirements and regulatory guidelines.
• Excellent communication, organizational, and problem-solving skills.
• Ability to work independently and collaboratively with a team.
• Proficiency in healthcare software and systems, including Epic.

Benefits:

• Competitive salary and benefits package.
• Opportunities for professional development and growth.
• Supportive and collaborative work environment.