Prior Authorization Specialist

Job Description

Job Description

We are looking for a Prior Authorization Specialist to support front-end revenue cycle operations for a long-term contract opportunity. This is a fully remote role but you must reside in Minnesota or Wisconsin. In this role, you will help secure timely coverage approvals, verify benefits, and clarify financial responsibility before services are delivered. This position works in a remote environment with collaborative team huddles and may support specialty areas such as cardiology, imaging, surgery, or other high-acuity service lines.

Responsibilities:

• Evaluate scheduled patient services and payer guidelines to determine when pre-service authorization or benefit validation is required.

• Obtain initial and follow-up approvals from insurance carriers to help prevent delays, denials, or gaps in coverage prior to treatment.

• Confirm medical, pharmacy, and plan benefits while identifying patient out-of-pocket responsibility and documenting accurate estimates when applicable.

• Review account details in the electronic medical record, update authorization status, and maintain complete documentation to support billing readiness.

• Interpret commercial, Medicare, and Medicaid coverage rules to ensure each case is processed in alignment with payer-specific requirements.

• Coordinate with internal teams and participate in daily remote huddles to resolve authorization issues and maintain productivity in a high-volume setting.

• Provide guidance to newer team members on authorization workflows, payer expectations, and front-end revenue cycle practices when needed.

• Support assigned specialty work queues based on business demand and complete additional related tasks as requested

• High school diploma or equivalent required.

• Must reside in MN or WI

• At least 6 months of recent experience performing prior authorization activities in a healthcare setting.

• Background in front-end revenue cycle functions, including insurance verification and benefits review.

• Working knowledge of commercial insurance, Medicare, and Medicaid plans, including coverage interpretation.

• Familiarity with medical terminology, clinical procedures, pharmacy benefits, and medication-related authorization needs.

• Experience using EMR or EHR platforms in a fast-paced, productivity-focused environment; Epic experience is preferred.

• Ability to assess patient financial responsibility and maintain accurate, detailed account documentation.

• Strong communication and organization skills with the ability to work effectively in a fully remote team environment.