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Prior Authorization Specialist

MedStar Washington Hospital Center | Lanham, MD | US

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General Summary of Position

Status: Full-time, 40-hours per weekSchedule: 11:00am-7:30pm with rotating weekendsLocation: 4390 Parliament Pl, Lanham, MD 20706 (Transfer Center)

Must be available for mandatory training schedule in the first 90-days of employment: Tuesday-Thursday, 8:00am-4:30pm (3 consecutive days, 1 week only).

Responsible for primary value patients accounts prior to billing. Obtains financial clearance, authorizations, insurance benefits and eligibility for designated department accounts. Interacts with patients and/or representatives in providing information associated with medical insurance coverage and financial responsibility.

Primary Duties and Responsibilities

  • Communicates timely updated insurance information to appropriate departmental parties. May assist registration with appropriate insurance guidance as needed. Stays up-to-date on insurance procedure and benefit changes and attends insurance seminars when available. Identifies insurance issues and provides feedback to appropriate supervisor.
  • Completes preadmission/pre-registration, maintenance of reservation files. Acts as a resource person to other departments, public and physicians concerning financial/insurance matters. Updates online computer files (SMS).
  • Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.
  • Counsels patient or representative, as needed, concerning: substantial unpaid or non-covered charges (preadmission, ASU, POP and concurrent admission); specific insurance coverage terms and limits (deductibles, co-insurance, etc); clarification of patient or guarantor responsibility to pay bill. Identifies accounts requiring insurance authorizations and benefits. Calls insurance companies and utilizes online insurance verification systems in a timely manner. May use CPT and ICD9 coding books as a resource, when needed by insurance carriers.
  • May interview patient or representative to: obtain basic patient demographic and financial information required for registration, and secure supplemental data concerning specific third party coverage.
  • Obtains the authorizations required to provide service. Ensures needed forms and signatures are obtained according to predetermined regulations and/or hospital policies. Notifies and secures HMO approvals. Screens and refers patients to advocacy when needed. Notifies and collects deposits (copays, deductible, etc.) from patients. Adheres to MedStar Financial Assistance Policy and procedures. Follows established Cash Reconciliation policy guidelines and may complete daily departmental deposit.
  • Verifies, analyzes, interprets and documents patient health insurance coverage, health plan provisions, or other third party hospital payment arrangements. Utilizes online verification tools.
  • Participates in meetings and on committees and represents the department and hospital in community outreach efforts. Participates in multidisciplinary quality and service improvement teams.
    • CUSTOM.PRIMARY.DUTIES.RESPONSIBILITIES.ADDENDUM

    Minimum Qualifications Education

    • High School Diploma or GED required and
    • Knowledge of medical terminology preferred

    Experience

    • 1-2 years Related experience required and
    • Medical terminology preferred

    Knowledge, Skills, and Abilities

    • Proficient use of hospital registration and support systems.
    • Working knowledge of various computer software applications.
    • Good analytical and problem-solving skills.
    • Excellent customer service skills.
    • Excellent organizational skills to manage multiple tasks in a timely manner.
    • Ability to work independently and as a member of a team.
    • Ability to work with third party payors.
    • Verbal and written communication skills.

    This position has a hiring range of $20.17 - $35.04


    Information :

    • Company : MedStar Washington Hospital Center
    • Position : Prior Authorization Specialist
    • Location : Lanham, MD
    • Country : US

    How to Submit an Application:

    After reading and knowing the criteria and minimum requirements for qualifications that have been explained from the Prior Authorization Specialist job info - MedStar Washington Hospital Center Lanham, MD above, thus jobseekers who feel they have not met the requirements including education, age, etc. and really feel interested in the latest job vacancies Prior Authorization Specialist job info - MedStar Washington Hospital Center Lanham, MD in 2025-09-26 above, should as soon as possible complete and compile a job application file such as a job application letter, CV or curriculum vitae, FC diploma and transcripts and other supplements as described above, in order to register and take part in the admission selection for new employees in the company referred to, sent via the Next Page link below.

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    Post Date : 2025-09-26 | Expired Date : 2025-10-26

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