Prior Authorization Specialist (Gastroenterology Specialty)

About the role

We are seeking a detail-oriented and patient-focused Gastroenterology Prior Authorization Specialist to support our growing GI practice. This role is responsible for obtaining insurance authorizations for gastroenterology procedures, diagnostic testing, medications, infusions, and specialty treatments.

Responsibilities

• Obtain prior authorizations for gastroenterology procedures, including colonoscopies, endoscopies, capsule studies, imaging, laboratory testing, biologic therapies, and specialty medications.
• Verify patient insurance benefits, eligibility, coverage, deductibles, co-pays, and authorization requirements.
• Submit authorization requests and required clinical documentation to insurance carriers.
• Monitor authorization status and proactively follow up with payers to ensure timely decisions.
• Communicate authorization approvals, denials, and appeals requirements to providers, staff, and patients.
• Prepare and submit appeals and supporting documentation for denied services.
• Maintain accurate patient insurance and authorization records within the EMR and practice management systems.
• Collaborate with physicians, nurses, schedulers, billing staff, and infusion teams to coordinate patient care.
• Respond to patient inquiries regarding insurance coverage and authorization status.
• Ensure compliance with HIPAA and all payer-specific authorization guidelines.
• Track authorization turnaround times and assist with process improvement initiatives.
• Stay current on payer regulations, gastroenterology treatment guidelines, and authorization requirements.

Requirements

• Experience working with insurance carriers, medical terminology, CPT and ICD-10 coding, and prior authorization processes within a physician practice or healthcare setting.
• Detail-oriented and patient-focused.
• Strong communication skills.
• Ability to work independently and manage multiple tasks simultaneously.
• Knowledge of gastroenterology procedures and treatments.

Qualifications

• Bachelor’s degree in healthcare administration, medical billing and coding, or a related field.
• Minimum 2 years of relevant experience in prior authorization or medical billing.
• Knowledge of CPT and ICD-10 coding.
• Proficiency in electronic health record (EHR) systems and practice management software.

Skills

• Excellent communication and interpersonal skills.
• Strong organizational and time management skills.
• Ability to work under pressure and meet deadlines.
• Attention to detail and accuracy in data entry and record keeping.
• Knowledge of healthcare laws and regulations, particularly HIPAA.

Benefits

Equal Opportunity Notice Highspring LLC (d/b/a Vaco by Highspring) and its parents, affiliates, and subsidiaries ("we," "our," or "Vaco by Highspring") are committed to the full inclusion of all qualified individuals and does not discriminate against any employee or applicant for employment because of race (including but not limited to traits historically associated with race such as hair texture and hair style), color, sex (includes pregnancy or related conditions), religion or creed, national origin, citizenship, age, disability, status as a veteran, union membership, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, political affiliation, or any other protected characteristics as required by applicable law. The company is also committed to ensuring that persons who need them are provided with reasonable accommodations; if an accommodation is needed to participate in the job application or interview process, please contact HR@vaco.com . Vaco by Highspring also wants all applicants to know their rights that workplace discrimination is illegal. Representation Notice By submitting to this position, you agree that you will be giving Vaco by Highspring the exclusive right to present your as a candidate for the foregoing employment opportunity. Additionally, you agree to be included in our talent pool for future hiring for similarly qualified positions. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. Lastly, you agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco by Highspring about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco by Highspring agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal. For residents of Ontario, Canada only: to the extent the position for employment is not with Highspring or not otherwise noted as vacant above, candidate should be informed that this role is to replace a presently employed person at Vaco by Highspring's client. Privacy Notice Vaco by Highspring respects your privacy and are committed to providing transparent notice of our policies. California residents may access Vaco by Highspring HR Notice at Collection for California Applicants and Employees here. Virginia residents may access our state specific policies here. Residents of all other states may access our policies here. Canadian residents may access our policies in English here and in French here. Residents of countries governed by GDPR and UK GDPR may access our policies here. Additionally, submissions to this position are subject to the use of AI to perform preliminary candidate screenings, focused on ensuring minimum job requirements noted in the position are satisfied. More details about Vaco by Highspring's use of AI can be found here (https://www.highspring.com/ai-use-notices/). Further assessment of candidates beyond this initial phase will be conducted by recruiters and hiring managers. Vaco by Highspring does not know and cannot opine on if its client's use of AI products in hiring. Pay Transparency Notice Determining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to: · the individual's skill sets, experience and training; · licensure and certification requirements; · office location and other geographic considerations; and · other business and organizational needs. With that said, as required by local law, Vaco by Highspring believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure. The individual may also be eligible for discretionary bonuses and/or participation in medical, dental, and vision benefits as well as the company's retirement plan (or similar retirement benefits).

Pay

Compensation for this role will be determined based on a variety of factors including but not limited to: · the individual's skill sets, experience and training; · licensure and certification requirements; · office location and other geographic considerations; and · other business and organizational needs. As required by local law, Vaco by Highspring believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure. The individual may also be eligible for discretionary bonuses and/or participation in medical, dental, and vision benefits as well as the company's retirement plan (or similar retirement benefits).

Schedule

The schedule for this role is typically Monday through Friday, with some flexibility based on the needs of the practice.