Prior Authorization Specialist

Description

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

The Registration Integrity Specialist plays a key role in ensuring patient safety and the accuracy of administrative data within the acute care environment. This position is responsible for pre-registration, order entry, cost estimation, and initial financial counseling. Working in direct communication with patients and clinical teams, the Registration Integrity Specialist verifies demographic and insurance information, identifies and corrects order errors, and supports accurate, timely, and complete registration processes. The specialist collaborates with revenue cycle departments, including Patient Accounting and Prior Authorization, to provide a seamless and supportive patient experience.

Essential Functions

• Perform real-time registration and pre-registration for scheduled and unscheduled patient visits.
• Verify and update patient demographic, insurance, and financial information accurately.
• Create and deliver accurate cost estimates and basic financial counseling to patients.
• Enter, review, and correct physician orders to ensure alignment with clinical documentation and enhance patient safety.
• Prepare necessary registration and consent documentation for front-end staff, including cost estimates when applicable.
• Provide registration backup support in clinical areas as needed.
• Collaborate with other departments across the revenue cycle to ensure smooth and efficient patient encounters.
• Utilize registration and order entry systems efficiently, including RapidFiler and Order Entry Desktop.
• Ensure compliance with hospital registration policies and documentation requirements.

Knowledge/Skills/Abilities/Expectations

• Strong understanding of hospital registration processes, insurance requirements, and patient financial counseling.
• Working knowledge of hospital billing principles and the ability to interpret insurance explanation of benefits (EOBs).
• Familiarity with Change Healthcare systems (AHIQA, Verifier, Estimator, Webpay, etc.).
• Competency in scheduling procedures and working with diagnostic and procedural coding.
• Proficiency in data entry and keyboarding.
• Excellent critical thinking, communication, and customer service skills.
• Ability to multitask in a fast-paced healthcare environment.
• Professional demeanor and ability to handle sensitive patient information with discretion.
• Prolonged periods of sitting and computer use.
• May be required to lift or move materials weighing up to 25 pounds.
• Frequent communication via phone and in-person.
• Office or clinical front-desk environment within an acute care hospital.
• May occasionally require coverage of various registration points throughout the hospital, including emergencyor specialty departments.
• Exposure to standard healthcare administrative and clinical settings.

Qualifications

Education

• High School Diploma or Equivalent including education equivalent to completion of secondary school or demonstrated ability to perform the essential functions of the role. (Preferred)

License/Certification

• None required at time of hire.

Experience

• 3+ years experience in customer service and/or revenue cycle operations, including registration, scheduling, or patient accounting (Required)
• Prior Experience using Change Healthcare products (Preferred)