Prior Authorization Specialist

About the role

Responsible for obtaining prior authorizations and pre-certifications for ancillary testing, procedures, medications, and specialty treatments to ensure timely patient care and compliance with insurance requirements. This role serves as a liaison between providers, patients, insurance companies, and ancillary service departments to facilitate approval of medically necessary services.

Responsibilities

• Obtain prior authorizations and pre-certifications for ancillary diagnostic testing and procedures.
• Verify patient insurance benefits and authorization requirements.
• Submit clinical documentation and supporting medical records to insurance carriers as required.
• Monitor authorization status and follow up with payers to ensure timely approvals.
• Communicate authorization approvals, denials, and pending requests to providers, clinical staff, and patients.
• Review denial determinations and coordinate appeals when appropriate.
• Maintain accurate documentation of authorization requests and outcomes within the electronic medical record (EMR) system.
• Ensure compliance with payer guidelines, regulatory requirements, and organizational policies.
• Collaborate with physicians, nurses, and ancillary departments to obtain necessary clinical information for authorization submissions.
• Assist with tracking authorization expiration dates and obtaining extensions when necessary.
• Provide exceptional customer service while maintaining patient confidentiality.

Requirements

• High school diploma or equivalent required; associate degree preferred.
• Previous experience in medical insurance verification, prior authorization, or healthcare administration preferred.
• Knowledge of medical terminology, diagnostic testing, and specialty medication authorization processes.
• Familiarity with EMR systems and insurance payer portals.
• Strong organizational, communication, and multitasking skills.
• Ability to work independently and manage multiple priorities in a fast-paced healthcare environment.
• Understanding of HIPAA regulations and patient confidentiality requirements.

Pay

$13/hour. Pay offered is based on experience, expertise, credentialing, and education.

Schedule

Business Hours EST.