Medical Coding & Prior Authorization Specialist
Apply for the Medical Coding & Prior Authorization Specialist position at Crossing Rivers Health .
Full Time, 40 hours per week
Crossing Rivers Health offers competitive pay and an excellent benefits package including medical, dental, vision, life insurance, short‑term disability, paid time off, a retirement plan with company match, and more.
Our core values are demonstrated in everything we do: Joy, Unity, Integrity, Compassion, Excellence.
Role Overview
The Medical Coding & Prior Authorization Specialist plays a dual role in supporting accurate clinical documentation and ensuring timely authorization of services for patients at Crossing Rivers Health. This position is responsible for coding all assigned encounter types, reviewing and correcting coding‑related denials, and managing prior authorization processes for specialty services, surgical procedures, therapies, and imaging. The goal of this role is to support compliance, maximize reimbursement, and ensure patients have timely access to medically necessary care.
Essential Job Functions
Review clinical documentation to ensure coding accuracy, completeness, and compliance with regulations.
Assign diagnoses, procedural/treatment, and professional billing codes for all patient type encounters utilizing ICD‑10‑CM, ICD‑10‑PCS, or CPT guidelines.
Apply modifiers, CCI edits, HCPCS, LCD/NCI regulations correctly.
Enter and verify data sequencing into the electronic health record.
Submit provider queries as appropriate following approved guidelines.
Identify and resolve clinical documentation and charge capture data discrepancies.
Initiate and manage prior authorization requests for surgical procedures, specialty services, imaging, and rehabilitation therapies.
Verify medical necessity and payer‑specific criteria prior to authorization requests.
Assist with denial follow‑up and appeals related to coding or prior authorization.
Collaborate with providers, nursing staff, and scheduling teams to obtain required clinical documentation for approvals.
Monitor pending authorizations, ensuring timely follow‑up and communication with payers, providers, and patients.
Track and report trends in authorization denials and coding discrepancies; participate in denial prevention initiatives.
Maintain current knowledge of payer guidelines, coding updates, and regulatory requirements.
Educate staff and providers on documentation and authorization best practices.
Contribute to a culture of accountability, continuous improvement, and patient‑centered service.
Assist with coding quality review activities for accuracy and compliance monitoring.
Competencies
Accountability – Accept responsibility and account for actions.
Accuracy – Perform work accurately and thoroughly.
Business Acumen – Understand business concepts and issues.
Communication – Convey ideas effectively and listen actively.
Detail Oriented – Pay attention to minute details.
Ethical – Demonstrate conduct conforming to values and standards.
Honesty/Integrity – Be truthful and credible.
Organized – Perform tasks systematically.
Reliability – Be dependable and trustworthy.
Responsible – Be answerable for conduct.
Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
Requirements
Education
High School Graduate or GED – Required.
Associate’s Degree in Health Information Management, Medical Coding, or related field – Required.
Registered Health Information Technician or related certification within 6 months of hire – Required.
Experience
2+ years of medical coding experience in a Critical Access Hospital or similar setting preferred.
Prior authorization and insurance verification experience preferred.