Prior Authorization Representative

Prior Authorization RepresentativeResponsible for reviewing scheduled patient services to determine prior authorization requirements and obtaining approvals. Provides support with insurance billing and posting while ensuring compliance with payer contracts, HIPAA, regulatory requirements, and the organization's Code of Conduct. Performs additional duties as assigned.Key ResponsibilitiesCustomer Service Deliver professional, courteous service to patients, staff, and external partnersHandle inquiries and concerns with discretion, diplomacy, and confidentialityMaintain a positive demeanor in high-pressure situationsAuthorization & Financial Support Identify services requiring prior authorization and obtain timely approvalsAssist with billing, posting, and resolution of unbilled encountersIdentify and report billing issues, system errors, or process gaps to managementCommunication & Teamwork Work collaboratively with clinical staff, payers, and internal departmentsCommunicate issues, data, and updates clearly and in a timely mannerParticipate in team meetings, training, and process improvement effortsQuality & Compliance Accurately document account activityEnsure compliance with payer rules, HIPAA, and internal policiesAssist in updating departmental procedures and training materials as neededProfessional Development Complete required training and attend educational opportunitiesStay current with payer regulations and authorization requirementsQualificationsEducation & Experience High School Diploma or GED requiredAssociate's Degree or equivalent coursework preferredMinimum 1 year of healthcare financial services, registration, or related experienceTyping speed of 30 WPM or greater preferredSkills & Abilities Strong customer service and communication skills (verbal and written)Ability to prioritize work and make routine independent decisionsBasic math and analytical skillsProficiency with word processing, spreadsheets, patient accounting systems, email, and internet applicationsAll offers contingent upon a post offer physical, urine drug screen, and background check.