Join the Team at Decatur County Memorial Hospital At Decatur County Memorial Hospital (DCMH), we are more than a healthcare provider—we are a trusted community partner committed to improving the health and well-being of the individuals and families we serve. As a critical access hospital, DCMH combines high-quality patient care, advanced medical services, and a compassionate, patient-centered approach in a welcoming rural healthcare environment.
Our team is made up of dedicated professionals who are passionate about making a difference every day. We foster a culture of collaboration, respect, integrity, and continuous improvement, where employees are empowered to grow professionally while contributing to exceptional patient outcomes. DCMH offers competitive compensation and benefits, opportunities for professional development, and a supportive workplace that values each team member's contributions.
DCMH offers more than just a job—we offer a rewarding career and a supportive workplace culture. Employees enjoy competitive pay, comprehensive health and wellness benefits, generous paid time off, retirement savings opportunities, professional development support, and a variety of additional benefits designed to help you achieve your personal and professional goals. We are committed to creating an environment where team members feel valued, supported, and empowered to grow.
If you are seeking a rewarding career with an organization that is committed to excellence, innovation, and service, we invite you to explore opportunities with Decatur County Memorial Hospital and become part of a team that is making a meaningful impact in our community.
Reports To: Authorization Manager
The prior authorization specialist is responsible for coordinating all aspects of the prior authorization process, including insurance and benefit verification, gathering necessary clinical information to ensure reimbursement requirements are met, and communicating with key stakeholders (providers, insurance co., and patients). The prior authorization specialist will contribute to the development of a standardized prior authorization process across the organization with initiative and autonomy.
Work
Standard work schedule. SKILLS & ABILITIES Education High school Education or GED. Two years college preferred.
Experience Six months previous experience in customer service. Knowledge of medical coding. Computer Skills Proficient in Microsoft Office, email and basic computer skills for other software used throughout the hospital for your area of responsibility.
Certificates & Licenses N/A Other Requirements Familiarity with medical terminology or willingness to learn. This position requires constant sitting, use of hands and fingers, reaching outward, lifting and carrying 0-10 lbs.
Insurance verification and benefit coverage. Follow payer processes to obtain prior authorizations and submit appropriate clinical documentation. Document and communicate completion of authorizations with appropriate personnel.
Review prior authorization denials, communicate reason, imitates appeals, and retro’s when necessary. Answers multiple phone lines, screening and forwarding calls, proving routine information and transferring callers and/or relaying messages to appropriate staff. Accurately enter required information (non-clinical and structured clinical data) into computer database & obtain pre-authorization and eligibility information.
Maintain cooperative working relationships with all DCMH departments, co-workers and providers. Support and participate in DCMH quality and PI initiatives. Call back payers and patient’s as needed and file completed precertification request as per established procedures Remain current on updates from payers to ensure reimbursement