• Pre-Authorization Specialist 1

    Scotland Health Care System (Laurinburg, NC)


    Job Title: Pre-Authorization Specialist

    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!