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!