[Hiring] Pre-Authorization Specialist I @Augusta Health

Role Description

The Pre-Authorization Specialist is an essential role responsible for facilitating exceptional patient experience by securing authorizations for all scheduled services related to medical and surgical admissions across entities. This position plays a critical role in supporting Augusta Health’s mission and advancing departmental goals through measurable performance indicators and service excellence.

• Generates and monitors worklists to ensure all scheduled appointments are properly reviewed and pre-authorizations secured.
• Verifies insurance coverage, collecting and documenting insurance benefits and authorization requirements.
• Acts as a subject matter expert in insurance benefits and authorization requirements.
• Obtains pre-certification for scheduled inpatient admissions electronically or via telephone.
• Ensures that authorizations for various services are obtained per timeline protocols.
• Documents and scans insurance authorization information in the appropriate fields within the computer system.
• Verifies all components of the authorization are correct.
• Accesses, analyzes, and selects relevant patient clinical information to support pre-authorization requests.
• Works closely with Financial Advocates to offer financial options for patients without insurance coverage.
• Reports denials and pending authorizations for scheduled services to management.
• Obtains retro authorizations for services and updates patient accounts.
• Provides regular feedback to management related to payer issues and authorization delays.
• Contacts insurance companies to verify insurance coverage and benefits.
• Identifies incomplete clinical documentation needed for service approval.
• Monitors pending cases to ensure approvals are obtained prior to admission or visit.
• Informs doctor’s office of any additional clinical requested.
• Assists reimbursement team in authorization-related corrections on rejected or denied claims.
• All other duties, as assigned.

Qualifications

• High School Diploma or GED equivalent.
• 1-year previous experience in patient/customer-facing role.
• Eligibility to work in the United States and meet Virginia state employment requirements.

Requirements

• Associate's degree preferred.
• CHAA certification with NAHAM (can be obtained on the job).
• AAPC Medical Coding Certification preferred.
• Knowledge of CPT and ICD-10 coding.
• Medical Terminology knowledge.
• Previous experience in hospital, healthcare practice, or health insurance company.
• Familiarity with Augusta Health’s systems, workflows, or organizational culture is a plus.

Benefits

• Comprehensive insurance package including medical, dental, and vision coverage.
• Retirement savings plans and financial wellness support programs.
• Generous paid time off and flexible scheduling to promote work-life balance.
• Career development programs including clinical ladders and advancement opportunities.
• Personalized onboarding with dedicated preceptors and ongoing educational support.
• Tuition reimbursement and access to onsite childcare.
• Free onsite parking and 24/7-armed security for safety.
• Competitive pay with shift/weekend differentials.
• Employee discounts at the cafeteria, gift shop, pharmacy, and local entertainment venues.