Prior Authorization Specialist

Position Summary

We are seeking a highly organized, detail-oriented, and proactive Prior Authorization Specialist to join our growing healthcare team. The Prior Authorization Specialist plays a critical role in ensuring patients receive timely access to medical services by obtaining and managing insurance authorizations for procedures, treatments, and services. This position requires strong knowledge of insurance verification, medical terminology, coding practices, and excellent communication skills.

Key Responsibilities

• Review, prepare, and submit prior authorization requests for medical procedures, treatments, and services.
• Verify patient insurance eligibility, benefits, and authorization requirements.
• Communicate effectively with healthcare providers, patients, and insurance representatives to obtain necessary documentation and information.
• Utilize ICD-10 and CPT coding knowledge to support authorization submissions accurately.
• Monitor and track authorization requests to ensure timely approvals and minimize delays in patient care.
• Maintain accurate and detailed records of authorization requests, approvals, denials, and follow-up activities.
• Follow up on pending authorizations and proactively resolve issues that may impact patient services.
• Assist with denied authorizations by gathering supporting documentation and preparing appeals as needed.
• Collaborate with medical and dental offices to streamline authorization workflows and improve operational efficiency.
• Ensure compliance with HIPAA regulations and company policies when handling confidential patient information.

Qualifications

• High school diploma or equivalent required; additional healthcare-related education preferred.
• Previous experience in prior authorizations, medical insurance verification, medical billing, or a healthcare office setting preferred.
• Strong understanding of medical terminology, insurance processes, and healthcare documentation.
• Excellent organizational skills with the ability to manage multiple tasks and deadlines.
• Strong problem-solving, analytical, and critical-thinking abilities.
• Exceptional written and verbal communication skills.
• Proficiency with electronic health records (EHR) systems and Microsoft Office applications.

Benefits

• Health Insurance
• Dental Insurance
• Vision Insurance
• Flexible Spending Account (FSA)
• Life Insurance
• Paid Time Off (PTO)
• 401(k) Retirement Plan
• Aflac Supplemental Benefits

Schedule

• Full-Time

Work Location

• In-Person

No Third Party Agencies or Submissions Will Be Accepted.  

Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP  

Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.