Pre-Authorization Specialist 1 Position Available In Scotland, North Carolina

Job Title:

Pre-Authorization Specialist Location:

Scotland Health Care System Job Description:

Scotland Memorial is seeking a dedicated and detail-oriented Pre-Authorization Specialist to join our team. The Pre-Authorization Specialist will be responsible for ensuring that diagnostic tests performed at Scotland Memorial for scheduled services are authorized in accordance with specific payer-provider requirements. This role is crucial in maintaining compliance and ensuring that patients receive timely and appropriate care.

Key Responsibilities:

Uses benefits and order information on file to initiate and secure pre-authorizations in advance of the scheduled date of service. Communicates with physicians, patients, and payers to secure and/or provide missing demographic, insurance, and/or clinical information to authorize service(s). Communicates with the Clinical Lead as needed on additional requirements to obtain the authorization. Documents all communications thoroughly, including payer decisions, in a timely manner. Identifies patients who may need Medicare Advance Beneficiary Notices (ABNs) and communicates with providers according to internal guidelines. Maintains a level of productivity suitable for the department. Maintains the Denial Goals for the Division. Provides backup coverage for OP Registration if there is a critical need as requested by Patient Access Manager or Director of PFS. Attends Revenue Cycle Academy as scheduled. Performs other duties as assigned.

Qualifications:

High school diploma or equivalent; additional education or certification in healthcare administration is preferred. Previous experience in a healthcare setting, particularly in pre-authorization or insurance verification, is highly desirable. Familiarity with payer policies, NCD, LCD ( preferred) Familiarity with Epic EHR (preferred) Strong attention to detail and organizational skills. Strong Time Management and prioritization skills Excellent communication and interpersonal skills. Ability to work independently and as part of a team. Proficiency in using healthcare management software and tools.

Benefits:

Competitive salary Health, dental, and vision insurance Retirement plan Paid time off Opportunities for professional development and growth New in 2025 – Paid Parental Leave!