Prior Authorization Specialist Primary

Prevea Health is an organization that values kindness, responsibility, inclusivity, wellness, and inspiration. We provide continuous education, training, and support to help every team member contribute to our success.

About the role

The Prior-Authorization Specialist is responsible for obtaining and verifying prior authorizations within the appropriate timeline for procedures, diagnostic tests, services, and medications. This role ensures compliance with insurance company policies, guidelines, and healthcare regulations while collaborating with healthcare providers, patients, and insurance representatives to secure necessary approvals.

Responsibilities

• Identify and obtain required preauthorization for procedures, diagnostic tests, services, and medications, ensuring completion to minimize claim denials.
• Coordinate with department providers, coding/billing staff, and insurance representatives to clarify information needed for proper authorization and timely payment.
• Review and interpret insurance coverage and policy guidelines to determine authorization requirements.
• Communicate with patients regarding their coverage for procedures, diagnostic tests, services, and medications.
• Accurately document and communicate final determinations in the patient’s medical record and to appropriate staff, providers, or patients.
• Work with internal teams to identify and address trends or issues in the prior authorization process.
• Provide feedback and recommendations to improve prior authorization workflows and efficiency.

Requirements

• High School Diploma and/or GED.
• 1-3 years of experience working in a medical or insurance role.

Skills

• Proficient telephone and computer skills with clear, professional communication.
• Excellent organizational and follow-through abilities.
• Strong communication skills with internal and external customers.
• Knowledge of insurance and medical terminology.
• Basic understanding of current CPT/ICD coding.
• Ability to provide exceptional customer service by assessing patient needs, meeting quality standards, and evaluating satisfaction.
• Empathetic and responsive to patient needs through active listening, asking appropriate questions, and seeking ways to assist.

Schedule

40 hours per week.