Prior Authorization Specialist

This position is responsible for obtaining prior authorizations for all procedural orders by successfully completing the prior authorization process per department procedure and protocol.

Our Mission: Quality, compassionate care for all.

Our Vision: Reimagine health care through connection, service and innovation.

Our Core Values: Be Kind | Trust and Be Trusted | Work Together | Strive for Excellence.

Join Our Prior Authorization Team at Logan Health!

Location: Remote (see approved states list)
Schedule: Day Shift – 8 Hours | Full-Time – 40 Hours

At Logan Health, we’re more than just healthcare providers – we’re a community. Located in the heart of Montana, we deliver exceptional care to patients while creating a supportive and collaborative work environment for our team. Join us to grow professionally, enjoy comprehensive benefits, and make a meaningful impact in a place you’ll be proud to call home.

Are you passionate about helping patients navigate the financial side of healthcare? We’re looking for a detail-oriented Prior Authorization Specialist to ensure a smooth and efficient process for obtaining prior authorizations for procedural orders.

Key Responsibilities:

• Obtain prior authorizations for facility and professional charges following departmental protocols.

• Submit CPT and HCPCS codes and medical records to insurers to expedite authorizations.

• Verify patient demographics and medical details, ensuring HIPAA compliance.

• Review and confirm all supporting documents and collaborate with necessary stakeholders.

• Prioritize authorization requests and ensure the accuracy of CPT and ICD-10 codes.

• Maintain intranet resources related to payer requirements for prior authorizations.

• Notify patients or clinics if authorization is not secured before service dates.

• Handle retro authorizations, resolve denials, and manage appeals as needed.

• Track all actions and update patient accounts accurately.

• Communicate issues like billing concerns, backlogs, and documentation needs to leadership.

• Adapt to changing circumstances to support patient flow.

• Maintain professionalism, integrity, and confidentiality in all interactions.

Basic Qualifications:

• 2+ years of experience in a hospital, specialty clinic, or medical billing setting focused on pre-certifications or prior authorizations.

• Knowledge of commercial and government insurance requirements, ICD-9/CPT codes, medical terminology, and HIPAA regulations.

• Familiarity with Microsoft Office and willingness to learn new software.

• Strong English communication skills, both written and verbal.

Preferred Qualifications:

• Associate or Bachelor’s degree.

• Experience with Meditech.

• Knowledge of managed care coverage, medical coding, and reimbursement procedures.

• Strong organizational skills, attention to detail, and task prioritization.

• Ability to work independently and as part of a team.

• Excellent interpersonal skills to handle confidential information professionally.

This position offers full-time remote work.  

To be eligible, you must reside in one of the following states:   

• Arkansas 

• Arizona 

• Colorado 

• Florida 

• Hawaii 

• Idaho 

• Illinois 

• Indiana 

• Kansas 

• Michigan 

• Missouri 

• Montana 

• Minnesota 

• New Mexico 

• North Carolina 

• Ohio 

• Oregon 

• South Dakota 

• Tennessee 

• Texas 

• Virginia 

• Washington 

• Wyoming 

Qualifications:

• Minimum of two (2) years’ experience in an acute care hospital, specialty clinic and/or medical billing office obtaining pre-certifications and/or prior-authorizations required.

• Possess knowledge and understanding of commercial and government insurance requirements, medical terminology, and rules and regulations governing the handling of private health information required.

• Possess a working knowledg