Prior Authorization Specialist

About the Role

This role is responsible for driving the foundational stages of the reimbursement cycle by managing initial and mid-stay authorizations, payor notifications, and daily billing system triaging. Securing timely authorizations and maintaining precise documentation is critical to preventing coverage gaps and administrative denials, ensuring steady revenue flow, and minimizing financial risk during a client's treatment stay.

Responsibilities

• Submitting initial authorization requests and tracking progress through final payor outcome to ensure coverage is active prior to service delivery.
• Managing and submitting new policy authorization requests for active clients who experience a change in coverage mid-treatment stay.
• Issuing timely notifications of non-admission to specific payors to remain compliant with strict contractual notice requirements.
• Triaging and prioritizing daily worklog tasks within the RCM billing system to resolve bottlenecks and keep claims moving forward.
• Executing ad hoc authorization and billing tasks as directed by management to support general department workflows and revenue capture.

Requirements

• 2–3 years of related work experience in healthcare administrative roles, specialized billing, prior authorizations, insurance verification, or claims management.
• Strong knowledge of prior authorization processes, payor portals, and medical billing practices.
• Proficiency with RCM billing systems and workflow triaging to effectively navigate and manage daily electronic task queues.
• Knowledge of all confidentiality requirements (HIPAA) regarding patients and strict maintenance of proper confidentiality on all such information.
• Excellent written and verbal communication skills for professional and persistent correspondence with insurance payors.
• Strict attention to detail to ensure complex authorization timelines, dates of service, and policy numbers are accurately recorded.
• Strong organizational and time-management skills to balance multiple mid-stay policy changes and time-sensitive payor notifications simultaneously.
• Able to work a hybrid schedule of 4 days/week in our Nashville office and located within 75 minutes' commuting distance of the office.

Benefits

Charlie Health is pleased to offer comprehensive benefits to all full-time, exempt employees. Read more about our benefits here.

Our Values

• Connection: Care deeply & inspire hope.
• Congruence: Stay curious & heed the evidence.
• Commitment: Act with urgency & don’t give up.

Please note: This role requires a hybrid schedule of 4 days/week in our Nashville office. Candidates must be located within 75 minutes' commuting distance of the office.