Prior Authorization Specialist

Job Description

Job Description

We are looking for a detail-oriented team member to support patient financial clearance and prior authorization activities. This Long-term Contract position focuses on reviewing scheduled services, confirming coverage requirements, and helping secure approvals before care is delivered whenever possible. The person in this role will work closely with clinical and operational partners in a fast-paced environment that values accuracy, communication, and consistent follow-through.

Responsibilities:

• Examine upcoming patient service details to determine whether insurance authorization or other financial clearance steps are required before treatment.

• Obtain initial and follow-up approvals from payers within required timelines to help prevent delays in care and reimbursement issues.

• Verify insurance coverage, interpret plan benefits, and document financial clearance outcomes with a high level of accuracy.

• Partner with clinical staff to review supporting documentation needed for authorization requests and resolve missing or incomplete information.

• Monitor accounts, work queues, and payer responses to address denials, notifications, and authorization-related issues promptly.

• Communicate with internal teams regularly in a remote setting, including team huddles and coordination across specialty-focused work groups such as cardiology, imaging, surgery, and specialty services.

• Provide guidance to less experienced team members when needed on revenue cycle practices, payer expectations, and policies that affect front-end clearance activities.

• High school diploma or equivalent required.

• Must reside in MN or WI

• At least 6 months of experience handling prior authorization tasks in a healthcare business office or insurance operations setting.

• Experience collaborating with clinical staff and working with clinical documentation in support of authorization or clearance activities.

• Working knowledge of insurance verification, benefits review, and patient financial clearance processes.

• Familiarity with commercial insurance, Medicare, and Medicaid plan structures and payer requirements.

• Strong written and verbal communication skills, with the ability to work effectively in a high-volume, productivity-driven environment.

• Understanding of medical terminology and healthcare procedures; experience with EMR or EHR systems such as Epic is preferred.

• Associate or vocational education in business, healthcare administration, public health, or a related field is preferred, along with prior experience in outpatient or inpatient healthcare settings.