Prior Authorization Specialist

Prior Authorization Specialist

The prior authorization specialist is responsible for coordinating all aspects of the prior authorization process including insurance verification, formulary reviews, gathering necessary clinical information from electronic medical record, and timely communication with patients, prescribers and physician office staff.

General Responsibilities:

• Assist patients with obtaining prior authorizations for medications, procedures, and referrals.
• Ensure medical necessity documentation is complete and accurate to support approvals.
• Collaborate with internal departments and providers to streamline the authorization process.
• Review and submit required forms, records, and supporting documents to insurance companies.
• Track and monitor authorization requests and follow up as needed.
• Work with supervisors or nurse managers to confirm treatment plans meet medical necessity criteria.
• Manage referrals and coordinate with external providers and pharmacies.
• Respond to insurance denials and submit appeals when appropriate.
• Document all authorization and referral details accurately in the EMR.
• Protect patient information and ensure compliance with HIPAA regulations.
• Schedule ancillary tests and provide patients with appointment details and instructions.
• Support communication between physicians, specialists, pharmacies, and patients.
• Maintain a clean and organized work environment and waiting area.
• Attend required staff meetings, huddles, trainings, and educational sessions.
• Train new staff and perform additional duties as assigned by the practice manager.
• Provide courteous, professional service to all patients and staff.
• Demonstrate punctuality, efficiency, and accountability in daily work routines.

Qualifications:

• Insurance verification experience, preferred (1 year)
• Medical billing experience, preferred (1 year)

If you are detail-oriented, organized, and passionate about supporting patient care through administrative excellence, we encourage you to apply and join our team in delivering high-quality healthcare services!

Salary: $18.00 to $24.50 per hour DOE