Prior Authorization Specialist

About this role

Job Description Summary At Logan Health, we're more than just a healthcare provider – we’re a community. Nestled in the heart of Montana, we are committed to delivering exceptional care to our patients while fostering a supportive and collaborative work environment for our team. As a member of Logan Health, you'll be part of a dynamic team that values compassion, innovation, and excellence. We offer opportunities for growth, comprehensive benefits, and a chance to make a meaningful impact in the lives of those we serve. Come join us and experience the Logan Health difference, where your passion meets purpose in a place, you’ll be proud to call home.

 Our Mission : Quality, compassionate care for all. Our Vision : Reimagine health care through connection, service and innovation. Our Core Values : Be Kind | Trust and Be Trusted | Work Together | Strive for Excellence. 

 Join Our Prior Authorization Team at Logan Health!

Location: Remote (see approved states) Schedule: Variable Shift – 8 Hours | Full-Time – 40 Hours

At Logan Health, we’re more than just healthcare providers – we’re  a community. Located in the heart of Montana, we deliver exceptional care to patients while creating a supportive and collaborative work environment for our team. Join us to grow professionally, enjoy comprehensive benefits, and make a meaningful impact in a place you’ll be proud to call home.

Are you passionate about helping patients navigate the financial side of healthcare? We’re looking for a detail-oriented Prior Authorization Specialist to ensure a smooth and efficient process for obtaining prior authorizations for procedural orders.

Key Responsibilities: • Obtain prior authorizations for facility and professional charges following departmental protocols.

• Submit CPT and HCPCS codes and medical records to insurers to expedite authorizations.

• Verify patient demographics and medical details, ensuring HIPAA compliance.

• Review and confirm all supporting documents and collaborate with necessary stakeholders.

• Prioritize authorization requests and ensure the accuracy of CPT and ICD-10 codes.

• Maintain intranet resources related to payer requirements for prior authorizations.

• Notify patients or clinics if authorization is not secured before service dates.

• Handle retro authorizations, resolve denials, and manage appeals as needed.

• Track all actions and update patient accounts accurately.

• Communicate issues like billing concerns, backlogs, and documentation needs to leadership.

• Adapt to changing circumstances to support patient flow.

• Maintain professionalism, integrity, and confidentiality in all interactions.

Basic Qualifications: • 2+ years of experience in a hospital, specialty clinic, or medical billing setting focused on pre-certifications or prior authorizations.

• Knowledge of commercial and government insurance requirements, ICD-9/CPT codes, medical terminology, and HIPAA regulations.

• Familiarity with Microsoft Office and willingness to learn new software.

• Strong English communication skills, both written and verbal.

Preferred Qualifications: • Associate or Bachelor’s degree.

• Experience with Meditech.

• Knowledge of managed care coverage, medical coding, and reimbursement procedures.

• Strong organizational skills, attention to detail, and task prioritization.

• Ability to work independently and as part of a team.

• Excellent interpersonal skills to handle confidential information professionally.

This position offers full-time remote work.     To be eligible, you must reside in one of the following states:     • Arizona  

• Arkansas  

• Colorado  

• Florida  

• Hawaii  

• Idaho  

• Illinois  

• Indiana  

• Kansas  

• Michigan  

• Missouri  

• Montana  

• Minnesota  

• North Carolina 

• Ohio  

• Oregon  

• Tennessee  

• Texas  

• Virginia  

• Washington  

--- Qualifications: • Minimum of two (2) years’ experience in an acute care hospital, specialty clinic and/or medical billing office obtaining pre-certifications and/or prior-authorizations required. 

• Possess knowledge and understanding of commercial and government insurance requirements, medical terminology, and rules and regulations governing the handling of private health information required.

• Possess a working knowledge and understanding of ICD-9 and CPT codes required.

• Possess insight and understanding into reimbursement and claims procedures and its direct impact on the revenue cycle required.

• Possess and maintain computer skills to include working knowledge of Microsoft Office Suite and ability to learn other software as needed. Meditech experience preferred.

• Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.

• Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.

• Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.

Job Specific Duties: • Responsible for obtaining accurate prior authorizations for facility and professional charges related to scheduled patient appointments per department procedure and protocol. 

• Performs timely and accurate submission of CPT, HCPCS codes and medical records to insurance carriers to expedite prior authorization requests.

• Accurately secures patients’ demographics and medical information and ensures all procedures are in line with HIPPA compliance and regulations.

• Reviews accuracy and completeness of information requested and ensures all supporting documents are present.  Collaborates with stakeholders as appropriate. 

• Prioritizes incoming authorization requests according to department procedure and protocol.  Confirms accuracy of CPT and ICD 10 diagnoses in the procedure order.

• Maintains the Logan Health intranet

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