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Prior Authorization Associate Jobs in Indiana (NOW HIRING)

Riverview Health

Authorization Specialist

Noblesville, IN · On-site

$17 - $22.50/hr

Obtains prior authorizations from third-party payers in accordance with payer requirements ... Associate degree in healthcare or business administration and/or related coursework, or comparable ...

RIVERVIEW HOSPITAL

Authorization Specialist

Noblesville, IN · On-site

$17 - $22.50/hr

Obtains prior authorizations from third-party payers in accordance with payer requirements ... Associate degree in healthcare or business administration and/or related coursework, or comparable ...

Riverview Health

Authorization Specialist

Noblesville, IN · On-site

$17 - $22.50/hr

Obtains prior authorizations from third-party payers in accordance with payer requirements ... Associate degree in healthcare or business administration and/or related coursework, or comparable ...

Riverview Health

Authorization Specialist

Noblesville, IN · On-site

$17 - $22.50/hr

Obtains prior authorizations from third-party payers in accordance with payer requirements ... Associate degree in healthcare or business administration and/or related coursework, or comparable ...

Integrated Resources

ELIGIBILITY ASSOCIATE

Indianapolis, IN · On-site

$13.75 - $19/hr

Eligibility Associate POSITION SUMMARY: The primary function/purpose of this job. The primary goal ... Provides inbound phone call support to the prior authorization team giving personal attention to ...

Valeris

Patient Care Associate

Jeffersonville, IN

Coordination of prior authorizations based on payer guidelines and in compliance with law, regulation or guidance. * Patient Assistance: * Review of patient assistance enrollment forms and any ...

Indianapolis IN

RCS Associate

Monticello, IN · On-site

$13.75 - $18/hr

Responsibilities may include, but are not limited to, scheduling, registration, insurance verification, prior-authorization, financial counseling/individual solutions, cashiering, release of ...

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Riley Hospital

RCS Associate

Monticello, IN · On-site

$13.75 - $18/hr

Responsibilities may include, but are not limited to, scheduling, registration, insurance verification, prior-authorization, financial counseling/individual solutions, cashiering, release of ...

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Prior Authorization Associate information

What is a prior authorization associate?

Prior Authorization Associates are professionals who handle the process of obtaining approval from insurance companies before certain medical services, procedures, or medications are provided to patients. They review clinical documentation, communicate with healthcare providers and insurers, and ensure all necessary information is submitted for timely authorization. Their work helps reduce claim denials and ensures patients receive the care they need while adhering to insurance requirements.

What are the key skills and qualifications needed to thrive as a prior authorization associate?

To thrive as a Prior Authorization Associate, you need a strong understanding of medical terminology, insurance processes, and prior authorization requirements, often backed by a high school diploma or associate degree. Familiarity with healthcare management software, electronic health record (EHR) systems, and payer portals is typically required. Excellent attention to detail, organizational skills, and effective communication are essential soft skills for this role. These skills ensure timely and accurate processing of prior authorizations, minimizing delays in patient care and supporting efficient healthcare operations.

What are some common challenges faced by a prior authorization associate, and how can they be effectively managed?

Prior Authorization Associates often encounter challenges such as navigating complex insurance requirements, handling high volumes of authorization requests, and managing tight turnaround times. Staying organized, keeping up-to-date with payer policies, and using robust tracking systems can help manage these difficulties. Collaborating closely with clinical staff and insurance representatives is also essential for resolving issues quickly and ensuring approvals are processed efficiently. Developing strong communication and problem-solving skills is key to success in this role.

What is the difference between Prior Authorization Associate vs Medical Billing Specialist?

AspectPrior Authorization AssociateMedical Billing Specialist
CredentialsHigh school diploma or equivalent; certification in medical billing or coding often preferredHigh school diploma or equivalent; certification in medical billing or coding often preferred
Work EnvironmentHealthcare offices, insurance companies, hospitalsHealthcare offices, billing companies, hospitals
Primary ResponsibilitiesObtain prior authorizations from insurance for procedures and treatmentsProcess and submit medical claims, handle billing and payments

The main difference is that a Prior Authorization Associate focuses on securing insurance approvals before procedures, while a Medical Billing Specialist manages the billing process after services are rendered. Both roles require similar credentials and often work in healthcare settings, but their core functions differ in the patient care and revenue cycle process.

Is a prior authorization associate a stressful job?

A prior authorization associate's job can be stressful due to the need for accuracy, meeting deadlines, and managing complex insurance requirements. The role often involves handling high volumes of requests and communicating with healthcare providers and insurers, which can contribute to workplace pressure.

What are the most commonly searched types of Prior Authorization jobs in Indiana?

The most popular types of Prior Authorization jobs in Indiana are:

What are popular job titles related to Prior Authorization Associate jobs in Indiana?

For Prior Authorization Associate jobs in Indiana, the most frequently searched job titles are:

What job categories do people searching Prior Authorization Associate jobs in Indiana look for?

The top searched job categories for Prior Authorization Associate jobs in Indiana are:

What cities in Indiana are hiring for Prior Authorization Associate jobs?

Cities in Indiana with the most Prior Authorization Associate job openings:

Prior Authorization Associate jobs near you

Prior-Authorization Spec (BMG)

Beacon Health System

South Bend, IN • On-site

$18.25 - $22.50/hr

Full-time

Re-posted 24 days ago

Beacon Health System rating

6.7

Company rating: 6.7 out of 10

Based on 145 frontline employees who took The Breakroom Quiz

533rd of 898 rated healthcare providers

Job description

Reports to the VP Patient Access responsibilities include evaluating designated referred services for authorization needs based on government and commercial payor requirements. Disseminating all clinical and coding supporting documentation to effectively complete the authorization process to ensure appropriate reimbursement. In addition, this position provides exceptional customer service during every encounter with patients, families, visitors and BMG associates by communicating with empathy and clarity regarding the details of the next step in care for the customer.
MISSION, VALUES and SERVICE GOALS
  • MISSION: We deliver outstanding care, inspire health, and connect with heart.
  • VALUES: Trust. Respect. Integrity. Compassion.
  • SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Prior Authorization Specialist duties in accordance with established policies and procedures by:
  • Serving as primary contact and resource for all designated prior authorization needs.
  • Identifying, collecting, and coordinating clinical documentation to support the qualification of ordered services
  • Evaluating orders for insurance coverage and authorization requirements.
  • Ensuring carrier process requirements are met within contracted guidelines and timeliness.
  • Ensuring proper testing is done
  • utilizing tools in accordance with the provider's desire and the testing
  • criteria and guidelines including both insurance and modality ordering
  • guidelines
  • Reviewing and complying with additional requests.
  • Validating completed authorizations to ensure the authorization corresponds with ordered service, code, time frame and provider.
  • Supporting the appeal process by communicating and coordinating resolution expectations with provider and authorization agent.
  • Maintaining standardized records to allow for effective coordinating, tracking and reporting of department actions and metrics.
  • Advocating for the customer by displaying the ability to recognize when to dispute a non-desirable outcome regarding PA approval (prior authorization).
  • Disputing and negotiating, when necessary, on behalf of BHS and the customer for a positive prior authorization outcome.
  • Providing exceptional customer centric service during every encounter with patients, families, and associates.
  • Using critical thinking skills to make decisions, identify problems, create solutions and helping to implement the change. Escalates concerns when necessary.
  • Participating in performance improvement (i.e. follows established work systems, identifies deviations or deficiencies in standards/systems/processes and communicates problems to supervisor or manage
  • Prioritizing work in an effective manner.
  • Working at a fast pace and maintaining accuracy.
  • Understanding the flow and
  • rhythm of each task and can connect each resulting convenient, connected
  • and coordinated care.
  • Using numerous
  • software platforms (multiple EMR's, insurance websites, referral database,
  • scheduling software, etc.) to conduct tasks for patient care.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:
  • Assisting others and/or
  • accept additional duties.
  • Enhancing professional growth and development through in-service meetings and educational programs as approved
  • Maintaining up-to-date knowledge and stays abreast of changes and updates as they occur. (Includes but not limited to, Insurance, Department and Processes changes.
ORGANIZATIONAL RESPONSIBILITIES
Associate complies with the following organizational requirements:
  • Attends and participates in department meetings and is accountable for all information shared.
  • Completes mandatory education, annual competencies and department specific education within established timeframes.
  • Completes annual employee health requirements within established timeframes.
  • Maintains license/certification, registration in good standing throughout fiscal year.
  • Direct patient care providers are required to maintain current BCLS (CPR), and other certifications as required by position/department.
  • Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
  • Adheres to regulatory agency requirements, survey process and compliance.
  • Complies with established organization and department policies.
  • Available to work overtime in addition to working additional or other shifts and schedules when required.

Education and Experience
  • The knowledge, skills and abilities as indicated are normally acquired through the successful completion of an Associate's Degree in Business or Health Care related field and one year medical authorization or related experience; or, in lieu of a degree, completion of a high school diploma or equivalent and three years medical authorization or related experience. Successful completion of an approved Medical Assistant Program with successful completion of the Certification Exam or equivalent medical office experience is preferred. Medical terminology, ICD-10, CPT, prior authorizations, third party payors and prior authorization processes is required.
  • Working knowledge of Microsoft Office: Outlook, Excel and Word.

Knowledge & Skills
  • Demonstrates well developed communication skills to communicate effectively and
  • clearly to a variety of internal and external contacts.
  • Demonstrates analytical skills necessary to solve problems and interpret data.
  • Promotes collaboration and innovation in the clinical services to ensure an
  • interdisciplinary approach to improving healthcare delivery and the
  • quality of patient care.
  • Must be tactful in handling patient problems often of a highly personal and
  • confidential nature.
  • Must be able to maintain professionalism during potential frustrating
  • interpersonal situations.
  • Demonstrates a high knowledge level of procedures, including knowledge of CPT codes
  • and ICD-10 Codes.
  • Demonstrates a working knowledge (referrals) high knowledge (prior authorization) of
  • insurance network guidelines to ensure the referral is scheduled in
  • accordance with customer's insurances rules and regulations
  • Exhibits a high level of understanding of payor requirements to effectively navigate the authorization process via website, fax or phone.
  • Knowledge of insurance and maintains up to date knowledge and stays abreast of changes and updates as they occur.
  • Possesses analytical skills necessary to apply knowledge and evaluate clinical information to resolve denials through various, complex levels of appeal.
  • Working knowledge of Microsoft Office: Outlook, Excel and Word
  • Possesses strong customer service, communication, organizational and analytical skills.

Working Conditions
  • Assigned hours within your shift, starting time, or days of work are subject to
  • change based on departmental and/or organizational needed.
  • May need to travel to other Beacon locations and may be required to work evening hours.
  • Working space is frequently congested by other personnel.
  • Constantly exposed to noise and distraction.

Physical Demands
  • Requires the physical ability and stamina to perform the essential functions of the position.
  • Sitting for long periods of time in front of a computer monitor

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