Prior Authorization Specialist in Watertown, WI at LifePoint Health

Date Posted: 12/21/2020

Job Snapshot

Job Description

Watertown Regional Medical Center

Watertown Regional Medical Center has a full time opportunity availaable for a Prior Authorization Specialist. This position will primarily work to complete prior authorizations/ pre- certifications for patient care for both primary and specialty providers. This position requires critical thinking in a high paced environment. Individuals in this role perform in accordance with hospital and Joint Commission standards and policies.

Essential Functions

  • Responds to customer requirements in a professional, friendly, prompt and caring manner, always maintaining the highest level of confidentiality and respect.
  • Demonstrates analytical ability to identify financial viability using web based sites and telephone verification directing questions to patients when necessary.
  • Receives and checks physician orders to insure that the order meets National Patient Safety standards.
  • Provides accurate prior authorization information to providers, payers and patients as needed. Answers, screens, prioritize, and determine urgency of prior authorizations.
  • Has working knowledge and understanding of insurance requirements, medical necessity and criteria needed to obtain prior authorizations
  • Routinely collaborates with ancillary WRMC services such as coding, billing and patient accounts
  • Documents necessary information relating to the prior authorizations in the EMR
  • Assists associates that are obtaining prior authorizations in other departments as needed and acts as a resource leveraging clinical expertise relative to the prior authorization process
  • Notifies providers of denials, helps to problem solve next steps, and with appeals, or reconsiderations as needed.
  • Facilitates Doctor to Doctor communication as needed to obtain prior authorizations
  • Routinely collects, and reports prior authorization data including volume, cycle time, lead time and first pass yield to Primary and Specialty clinic directors.
  • Obtains and accurately records all patient information necessary for the proper care and treatment of the patient.

Job Requirements


Min HS Diploma or equivalent.   At least 1 year of commercial, vocational, or other specialized training beyond high school required.

Minimum five years previous related experience in healthcare field required. Minimum of one year Prior Authorization experience preferred.

Required Skills

  • Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
  • Must be able to work in a stressful environment and take appropriate action.
  • Always maintain the highest professional level in demeanor and communication.
  • Basic reading and math skills
  • Clerical and record keeping skills
  • Excellent communication and interpersonal skills
  • Critical thinking ability
  • Follow procedures related to position and accountabilities
  • Knowledge of diagnostic procedures and tests
  • Data entry and keyboarding skills
  • Computer skills. Proficient with Microsoft Office – Word, Excel, Outlook
  • Basic medical terminology
  • Ability to use office machines - fax, copier, computer, headset, printers
  • Must be able to learn and work in Verata Prior Auth software

Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran