Payer Notification III

About the role

The Patient Access Services (PAS) Prior Authorization Specialist III position reports to the PAS Manager of Pre-Service Operations and is responsible for securing accounts by performing a combination of insurance verification and validating prior authorization with payers before services are rendered. This position works with physicians, nurses, clinic managers, and financial advocates to resolve issues that arise during the prior authorization process.

Responsibilities

• Verifies insurance eligibility, benefits, and network status, and creates pre-service liability estimates.
• Secures prior authorizations for scheduled and non-scheduled services.
• Acts as a liaison between payers and clinic schedulers/medical support staff.
• Follows up on delayed or denied authorization requests and escalates for resolution.
• Creates detailed documentation and maintains/stores the authorization paper/electronic trail.
• May work in work queues to resolve claims denials related to prior authorization.
• Performs other work-related duties as requested/directed by management.

Requirements

• High School Diploma or equivalent required; Associate's degree or higher preferred.
• Minimum 1 year of healthcare experience in Patient Access Services, Practice Operations, or Patient Financial Services; Bachelor's degree or higher may substitute for experience.
• Required certifications: CHAA, CPAR, CRCR, or CRCR-P (within 120 days of hire).
• Epic experience preferred.

Skills

• Effective communication skills (both written and verbal) with the ability to communicate with various members of the healthcare team.
• High attention to detail, self-directed, and a positive attitude are essential.
• Effective problem-solving and critical thinking skills.
• Typing or data entry competency of at least 40 words/minute.
• Cash handling and balancing.
• Demonstrated professionalism, effective communication skills, and active listening skills.
• Working knowledge of patient registration systems and intermediate Microsoft Office Suite are preferred.

Benefits

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.