Top 2 Prior authorization specialist Jobs in Boone, Nc

Medical Billing Specialist
Appalachian State University —Boone, NC
- $48,004 - $50,530 a year
- Full-time
- HIPAA
- Mid-level
- Mentoring
Experienced Prior Authorizations Specialist - Pain Management
Envision Pain Management —Boone, NC
- $17 - $24 an hour
- Full-time
- Nursing
- HIPAA
- Mid-level
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Medical Billing Specialist

Appalachian State University -
Boone, NC

Apply Now

Job Details

Full-time
$48,004 - $50,530 a year

Qualifications

Student supervision
Program management
Overseeing health insurance pre-certification
Serving clients
Team leadership
Provider enrollment for medical credentialing
HIPAA
Financial performance report preparation
Healthcare referral management
Student support
Financial data management
Health information regulatory compliance
Medical claims submission
Clinical confidentiality policies
Managing patient records
Medical claim status updates
Standard operating procedures drafting

Full Job Description

Posting Details

Work experience or education that is NOT included on the application will NOT be considered when screening your application. Please include ALL work experience and education on the application to ensure that you receive the appropriate credit toward qualification for this position.

Position Summary Information

Classification Title

University Program Associate

Working Title

Medical Billing Specialist

Location

Boone, NC

Job Category

Position Number

062941

Not Eligible for Visa Sponsorship

VISA sponsorship is not available for this position. All candidates must be eligible to work and live in the U.S

Department

Appalachian Institute for Health and Wellness - 273600

Primary Purpose of Position

To execute all billing and credentialing for all AppWell clinic facilities.

Claims Submission: Prepare, review, and transmit claims to insurance companies(commercial and government) for reimbursement.
Revenue Cycle Management: Monitor claim status, follow up on unpaid claims, and appeal denied claims to ensure timely payment.
Patient Billing: Calculate patient responsibility, send patient statements, and handle inquiries about bills.
Compliance: Adhere to HIPAA regulations to maintain patient confidentiality and comply with all legal/payer requirements. Provide front desk back up support to the LLHS Clinic Front Desk as needed. Be available to train student interns, graduate assistants, and student employees as appropriate. Serve as a mentor modeling professional behavior. Execute Insurance provider enrollment processes and set up. Execute Initial setup and maintenance of credentialing for all affiliated providers. Update and maintain all CAQH Provider Profiles. Proper use and assignment of billing codes.
Knowledge of HIPAA regulations. Stay up to date on appropriate billing codes and procedures. Balance end of day according to clinic policies and procedures. Track payments from all sources including Touchnet, Clover, Zealous, Availity, WayStar, (and others) as well as Student Accounts. Obtain prior authorizations as needed for allied health provider services.

Minimum Qualifications

Bachelor’s degree; or equivalent combination of training and experience. All degrees must be received from appropriately accredited institutions.

License/Certification Required

Essential Job Functions

The Medical Billing Specialist conducts all billing services for the AppWell Clinic and act as the electronic health records administrator. This role:

provides clients with a written/and/or verbal determination of fees for all clinical services (evaluation, screening, therapy, etc.
establishes and monitors accounts payable and receivable for all clients
is responsible for all insurance processes such as patient benefit inquiries, prior approval processes and physician referral requests
submits insurance claims by standard or electronic methods
updates, monitors & follow-ups all electronic & paper claims
monitors delays and denials of claims and prior approval requests.
assists with data collection for statistical reports.

This role has extensive phone & e-mail contact with Medicaid, Medicare, BCBS of NC, other healthcare plans, state & local agencies including CDSA. They will be responsible for insurance provider enrollment process and set-up.

Secondary responsibilities include assisting office staff, students and clinical faculty with routine and complex office procedures, including electronic health records. Assisting with public inquiries about clinical services and fees, client scheduling, policies & taking referral information. Conducting client file reviews and audits. Updating additions and/or deletions to the clinic materials database. Ordering of clinic diagnostic / therapy test materials and forms.

Knowledge, Skills, & Abilities Required for this Position

Knowledge of Electronic Health Records and billing policies and insurance guidelines for multiple insurance agencies.
Must be able to oversee all insurance processes including benefit inquires, prior approvals, and physician referrals.
Update and monitor electronic and paper claims.
Ensure insurance provider enrollment process and set up.
Work with Electronic Health Records and oversee implementation of electronic billing process. Proper use and assignment of billing codes.
Knowledge of HIPAA regulations.

Preferred Qualifications

Basic office skills, supervisory skills and the ability to produce and evaluate data
Ability to work independently and without instruction, to handle pressures, to prioritize work and stay focused in a busy environment, to make administrative decisions, to be patient and flexible in a demanding environment, and to provide instruction and oversight for graduate assistant students
Special consideration will be given to individuals with knowledge of electronic health records, private-pay, third party and insurance billing, including claim submissions
Special consideration will also be given to individuals with a certificate or associate’s degree in medical billing and coding.

Required Functional Competencies to Successfully Perform Job Duties.

Knowledge-Program & Organization

Knowledge of state, federal, policy interpretations and precedents affecting program areas(s) and unique situations. Ability to analyze and explain revisions and implement initiatives. Ability to draft and recommend new procedures. Knowledge of state, federal, policy interpretations and precedents affecting program area(s), and unique situations. Ability to analyze and explain revisions, and implement initiatives. Ability to draft and recommend new procedures. Operational knowledge and the ability to articulate the purpose of the program’s organization including its mission, services, clients and measures of business effectiveness in order to adapt processes, procedures and activities to meet needs. Ability to identify, understand and provide possible resolutions for unique issues and problems that with broad impact and/or a broad range of client services. Ability to lead teams in the modification of processes using applicable technology web-based data systems and programs.

Program Administration

Ability to establish expectations and clear directions for a defined program area independently. Ability to make decisions regarding the program expectations and direction to ensure program outcomes and timelines are met. Ability to identify, understand, and provide corrective alternatives for issues and problems of a more complex nature. Ability to adjust program priorities based on changing work environment and deadlines. Ability to analyze and develop information for monitoring and measuring work processes. Ability to determine program effectiveness and efficiency. Ability to identify trends in program operations or activities and make recommendations. Ability to manage the reporting of financial area or program(s), including preparation and analysis of financial statements and reports.

Customer Service
Ability to enhance collaboration among individuals and groups. Ability to build consensus when dealing with opposing points of view, and resolve competing or complex issues. Ability to promote a high level of integrity among all staff. Ability to engage and act in the best interests of the organization by aligning service delivery with strategic goals and client’s needs. Knowledge of the unique needs of clients and ability to provide responsive services/answers tailored to their requirements. Ability to maintain quality service standards and recommend improvements. Applies an in-depth knowledge of a variety of complex processes and procedures and independently performs those tasks.

Type of Position

Permanent Full-Time

Staff/Non-Faculty

Staff/Non-Faculty

Appointment Type

1.0

Work Schedule/Hours

Mon-Fri 8:00-5:00pm

Number of Hours Per Week

Number of Months Per Year

Mandatory Staff

Physical Demands of Position

To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential job functions.

Overall Competency Level

Advanced

Salary Grade Equivalency

GN09

Salary Range

Anticipated Hiring Range

$48,004 - $50,530

Pay will be commensurate with applicant competencies, budget, equity and market considerations.

Posting Details Information

Posting Date

07/15/2026

Closing Date

08/12/2026

Competency Level Statement

Management will only consider applicants who meet the required competencies.

Special Instructions to Applicants

Please attach required documents:

Resume
Cover Letter
List of Reference with Contact Information

Search Chair Name

Bryan Belcher

Search Chair Email

[email protected]

Applicant Pool Preference

External (Post on the Web)

Departmental Information

Quick Link

https://appstate.peopleadmin.com/postings/55151

Posting Number

201503004P

Apply Now

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prior authorization specialist jobs in boone, nc

Medical Billing Specialist

Experienced Prior Authorizations Specialist - Pain Management

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