Prior Authorization Clerk

 

Trego County Lemke Memorial Hospital - H.I.M. is seeking a Full-time Prior Authorization Clerk

·  Full-time position available - 40 hours per week
 

The individual will be responsible for verifying eligibility and obtaining insurance benefits, ensuring precertification/ authorization and referral requirements are met before delivery of outpatient and ancillary services, and working with providers and nursing staff in the authorization process. 

 

RESPONSIBILITIES 

·         Reviewing patient medical records, insurance benefits, and eligibility to confirm coverage for requested services. 

·         Completing and submitting accurate prior authorization forms to insurance companies, including relevant clinical information and supporting documentation. 

·         Contacting healthcare providers to gather additional information needed for prior authorization requests and following up with insurance companies regarding approval status.

·         Understanding medical necessity criteria and collaborating with clinical reviewers to ensure appropriate authorization decisions. 

·         Identifying and resolving potential issues with prior authorization denials, including appeals and re-submissions. 

·         Maintaining accurate records of prior authorization requests within the electronic health record system, tracking progress, and monitoring deadlines. 

·         Staying updated on insurance plan guidelines, regulatory requirements, and industry standards related to prior authorization processes. 

·         Accepts other duties as assigned.

QUALIFICATIONS & SKILLS 

·         High School graduate or equivalent.

·         Two years of clinical or medical office/billing experience is preferred.

·         Computer experience required.

·         Understanding of insurance payers and authorizations.

·         Strong understanding of medical terminology and healthcare billing codes. 

·         Ability to effectively communicate in verbal, nonverbal, and written forms; proficient in English language.

·         Ability to deal with a variety of personalities/situations that require tact, judgment, and poise. 

·         Must be able to maintain confidentiality.

·         Detail-oriented with strong organizational skills to manage multiple tasks efficiently.

Our application must be completed to be considered for this position. Please send your application, resume, education, licensure/certifications (if applicable) to Human Resources, 320 N. 13th St., WaKeeney, KS 67672. They may also be dropped off at the hospital business office, emailed to  hr@tclmh.org or faxed to (785) 743-6317. To request an application by mail or email, please email or call (785) 743-2182.  Applications also available on our website: www.tclmh.org 

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Salary commensurate with education and experience. We offer a negotiable nationally competitive salary and excellent benefits.

We are a progressive CAH hospital with in-patient, swing bed, out-patient, home health, assisted living, long-term care, and clinic services.

Candidates must be energetic, possess strong leadership skills, willing to work as a team, have a positive attitude, friendly and compassionate toward patients.

For hospital information: www.tclmh.org

For community information: www.tregocountyks.com

TCLMH is an Equal Opportunity Provider/Employer (EOE) and a tobacco-free campus