Job Details

Prior Authorization Specialist - Join Our Referral Team!

Boone Memorial Hospital - Madison, WV Full-Time

Boone Memorial Hospital is seeking a detail-oriented, customer-focused Prior Authorization Specialist to support our Referral Department. This role ensures that all medical referrals are processed accurately, timely, and with exceptional service to our patients, providers, and clinical teams. If you thrive in a fast-paced administrative environment and enjoy helping patients navigate their care, we invite you to apply.
Why You'll Love Working Here

• A supportive and collaborative referral and clinical team
• A meaningful role that directly impacts patient access to high-quality care
• Opportunities to enhance your skills in medical terminology, insurance processes, and healthcare administration
• A workplace that values professionalism, respect, and patient-centered service

• Receive, process, schedule, and follow up on all medical referrals
• Maintain communication between multiple clinical disciplines on behalf of patients
• Interact professionally with patients, families, co-workers, and providers
• Answer phones, emails, and faxes in a timely and efficient manner
• Complete referral forms, track all referrals, and maintain accurate logs
• Monitor reports and logs to stay aware of pending or outstanding referrals
• Follow up on referrals for completeness, accuracy, and required documentation
• Enter patient data accurately into CPSI, EMR, or other systems as required
• Share referral data with specialists professionally and securely
• Apply knowledge of ICD-10 and CPT coding to process referrals correctly
• Maintain confidentiality and adhere to HIPAA and all regulatory requirements
• Support ethical and professional business practices at all times

• Excellent verbal and written communication skills
• Strong customer service and interpersonal abilities
• Exceptional organizational skills and attention to detail
• Ability to prioritize, multitask, and manage time effectively
• Problem-solving and analytical skills
• Proficiency with Microsoft Office and general computer systems

• Prolonged periods of sitting and computer work
• Ability to lift up to 25 lbs when needed

• High school diploma or equivalent

• Associate degree in Medical Office Administration
• One or more years of experience in healthcare, medical office, or related field
• Knowledge of ICD-9/ICD-10 and CPT coding