Prior Authorization Specialist

Back Prior Authorization Specialist – #25-599 Location: Green Bay, Wisconsin, United States Job Summary The Prior Authorization Specialist at Prevea Health is responsible for obtaining and verifying prior authorizations within the appropriate timeline for procedures, diagnostic tests, services, and medications. This role ensures that all requests comply with insurance company policies, guidelines, and healthcare regulations. The specialist collaborates with healthcare providers, patients, and insurance representatives to obtain the necessary approvals. Responsibilities Identify and obtain the required preauthorization for procedures, diagnostic tests, services and medications. See the process through completion to minimize denial of claims. Coordinate with department providers, coding/billing staff, and insurance representatives to ensure understanding of information needed to obtain proper authorization for payment within the appropriate timelines. Review and interpret insurance coverage and policy guidelines to determine authorization requirements. Communicate with patients as needed for procedures, diagnostic tests, services and medications to provide coverage information. Accurately document and communicate final determination in the patient’s medical record and to appropriate staff, providers, or patient. 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. Education & Qualifications High school diploma or GED. 1-3 years of experience in a medical or insurance role. Skills & Abilities Proficient telephone and computer skills with clear and professional speaking abilities. Excellent organizational skills. Excellent communication skills and follow-through with internal and external customers. Knowledge of insurance and medical terminology. Basic knowledge of current CPT/ICD coding. Equal Employment Opportunity/Affirmative Action Employer Prevea is an Equal Employment Opportunity/Affirmative Action employer. #J-18808-Ljbffr