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Afternoon Prior Authorization Representative Express Scripts Jobs in Kansas

HaysMed

Prior Authorization Representative

Hays, KS · On-site

$15.75 - $20/hr

A Hospital Prior Authorization Representative assesses patient medical records, prepares and submits authorization requests, and liaises with insurance companies to resolve issues. They also inform ...

HaysMed

Prior Authorization Representative

Hays, KS · On-site

$18 - $26/hr

A Hospital Prior Authorization Representative assesses patient medical records, prepares and submits authorization requests, and liaises with insurance companies to resolve issues. They also inform ...

Quipt Home Medical

Customer Service Representative

Lenexa, KS · On-site

$15 - $20.50/hr

Customer Service Representative Position Reports To Branch Manager/CSR Director Position Summary As ... CMN Requirements and Prior Authorizations * Documentation Requirements of the Equipment * Patient ...

Quipt Home Medical

Customer Service Representative

Salina, KS · On-site

$15.25 - $20.75/hr

Customer Service Representative Position Reports To Branch Manager/CSR Director Position Summary As ... CMN Requirements and Prior Authorizations * Documentation Requirements of the Equipment * Patient ...

The Salvation Army

Backroom Attendant

Lawrence, KS

$13.75/hr

Prescription Coverage with Express Scripts - mail-order options for convenience and lower costs ... Represent The Salvation Army with professionalism and a positive attitude Safety & Team Support

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The Salvation Army

Store Sales Associate I

Olathe, KS

$13.75/hr

Provide excellent customer service and represent The Salvation Army's mission and values * Greet ... Prescription Coverage with Express Scripts - mail-order options for convenience and lower costs.

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Afternoon Prior Authorization Representative Express Scripts information

What cities in Kansas are hiring for Afternoon Prior Authorization Representative Express Scripts jobs? Cities in Kansas with the most Afternoon Prior Authorization Representative Express Scripts job openings:
Afternoon Prior Authorization Representative Express Scripts jobs near you
Infographic showing various Afternoon Prior Authorization Representative Express Scripts job openings in Kansas as of July 2026, with employment types broken down into 1% As Needed, 54% Full Time, 36% Part Time, 1% Temporary, 2% Contract, and 6% Nights. Highlights an 98% Physical, and 2% Remote job distribution.

Prior Authorization Representative

HaysMed

Hays, KS • On-site

$15.75 - $20/hr

Full-time

Re-posted 29 days ago

Job description

Position Summary: This position is the frequently the first contact a patient has with the HMC system.  A Hospital Prior Authorization Representative assesses patient medical records, prepares and submits authorization requests, and liaises with insurance companies to resolve issues. They also inform patients about request statuses, maintain detailed records, ensure compliance, collaborate with healthcare staff, address issues, and generate reports on authorization activities. Correctly identifies the patient, matches medical records, and facilitates hospital care, collect all required information necessary to meet state/federal regulations and to satisfy HMC billing processing requirements, including insurance coverage. This position requires excellent customer services skills and an ability to be able to explain to people what information is necessary and the rationale.

Position Details:

  • Collection of demographic information using Meditech (Electronic Medical Record)
    • Collect basic personal information from patient including age, race, ethnicities
    • Collect addresses, phone numbers and other contact information
    • Collect next of kin information
    • Collect insurance/coverage information. Be able to discern what information is required based on type of insurance, i.e., on the job injury, motor vehicle accident, etc.
    • Sequence the insurance in the correct order according to guidelines
    • Based on specific criteria, request additional information, i.e. MSPQ/COB
  • Verification of insurance coverage using AccuReg
    • Review feedback from AccuReg for any issues related to non-coverage or data accuracy
    • Review with the patient any feedback and reconcile accordingly
    • Ability to decipher the appropriate action based on AccuReg feedback, i.e., change the information in Meditech or enter a dispute so a more senior person can review
    • Verify insurance prior to the call
  • Completion of Prior Authorization
    • Assessing patient medical records and documentation to determine the necessity of procedures and treatments.
    • Completing all the required fields and making accurate and complete notes to assist the HMC colleague who completes registration on site
    • Preparing and submitting prior authorization requests to insurance companies for approval.
    • Liaising with insurance companies to follow up on pending authorizations and resolve any issues or discrepancies.
    • Informing patients about the status of their authorization requests and explaining any delays or denials.
    • Keeping detailed records of all authorization requests, approvals, denials, and communications with insurance providers.
    • Ensuring all authorization processes comply with hospital policies, insurance guidelines, and regulatory requirements.
    • Working closely with healthcare providers, billing departments, and other hospital staff to ensure smooth and efficient authorization processes.
    • Addressing and resolving any issues that arise during the authorization process, including appeals for denied requests.
    • Generating reports on authorization activities, including approval rates, turnaround times, and any trends or issues identified.

Qualifications: 

  • Required
    • High school diploma or equivalent is required.
  • Preferred           
    • Two to three years of working in healthcare office setting 
    • Accuracy and attention to detail. Proactive approach to problem-solving and process improvement.
    • Strong verbal and written communication skills, good organizational skills, efficient in computer operations including Microsoft Word, Excel, and Teams.
    • Professional and courteous demeanor, excellent office and phone etiquette.
    • Coding Certificate

Patient Interaction: Continuous

HIPAA: This position will have access to the following Protected Health Information in order to perform the duties related to their position at Hays Medical Center based on the following criteria:

  • Primary – required (routine) to do the job
    • Patient demographics
    • Insurance/Coverage information:
    • Scheduled service/provider
  • Secondary   - occasionally necessary to perform the job
  • None- no approved access
    • Clinical information beyond type of service
    • Coding

Description of Information
Primary:
Patient Demographic Information (information used to identify a person): Name, Date of Birth, Address, Race, Marital Status, Religion

Secondary:
Clinical Information (information that describes a patient’s health status): Diagnosis, Reports/Medical Notes, Test Results, Problem List, Procedures, History and Physical
Coding Information (clinical information that is in (alpha) numeric format): ICD-9 Codes, Rev Codes, CPT Codes
Financial Information/Insurance (information related to insurance, billing and payment): Billing Information, Payer Name, Payer ID, Account Balances, Plan Elements Covered, Payment Information, Payment Rates

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