Prior Authorization Specialist

Position Summary

Holon Health is looking for a detail-oriented Prior Authorization Specialist to support our healthcare operations team. This role focuses on reviewing medical charts, gathering required clinical documentation, entering accurate information into payer portals or authorization forms, and submitting prior authorization requests.

What You'll Do

• Review medical charts and clinical documentation to identify information needed for prior authorization submissions.
• Prepare and submit prior authorization requests through payer portals, fax, or other required submission methods.
• Enter client, provider, insurance, diagnosis, CPT, service, and clinical information accurately into authorization forms or payer systems.
• Gather and organize supporting documentation required for authorization approval.
• Verify that submitted authorization requests include complete and accurate clinical and administrative information.
• Track prior authorization requests from submission through determination.
• Update internal logs, spreadsheets, systems, and records with authorization status, submission dates, approval dates, expiration dates, reference numbers, and payer responses.
• Identify missing, incomplete, or inconsistent information and escalate to the appropriate team member.
• Communicate with internal teams regarding documentation needs, authorization status, payer requirements, and follow-up items.
• Absorb pending, denied, expired, or expiring authorizations.
• Maintain accurate records to support billing, claims submission, and compliance workflows.
• Follow established workflows, payer requirements, and internal standard operating procedures.
• Maintain confidentiality of client, medical, claims, and insurance information in accordance with HIPAA and company policies.
• Support Revenue Cycle Management and Practice Management teams with authorization-related documentation and administrative tasks.
• Other duties as assigned.

Requirements

• Previous experience with prior authorizations, medical records review, healthcare billing, insurance verification, revenue cycle management, or healthcare administrative support preferred.
• Ability to read and interpret medical charts, clinical documentation, diagnoses, treatment notes, and service information.
• Basic understanding of healthcare insurance, payer requirements, CPT codes, diagnosis codes, and authorization workflows preferred.
• Strong attention to detail and accuracy.
• Comfortable entering and reviewing large amounts of information accurately and efficiently.
• Comfortable working with payer portals, EHR systems, spreadsheets, and internal tracking tools.
• Strong organizational and time management skills.
• Ability to follow written processes and standard operating procedures.
• Ability to work independently in a remote environment.
• Clear written communication skills.
• Familiarity with HIPAA, healthcare privacy, and handling confidential information.
• Ability to work in a fast-paced, startup environment where priorities may shift.