Pre-Authorization Specialist

MotivHealth Insurance Company • South Jordan, UT

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About The Position

The Pre-Authorization Specialist plays a critical role in ensuring that medical services requiring prior approval are reviewed, processed, and documented accurately and efficiently. This position serves as a liaison between providers, members, and internal teams to obtain necessary information for pre-authorization decisions, ensuring compliance with plan guidelines, state and federal regulations, and contractual requirements. We are looking for someone who has at least 2 years of experience with medical coding, healthcare administration, or processing claims, who is eager to learn and develop with a rapidly growing innovator in the self-funded insurance space!

Requirements

• Required 2 years of healthcare financial experience or equivalent and previous experience with medical insurance and prior authorizations.
• Familiarity with human anatomy, medical terminology, and ICD-10/CPT coding.
• Strong critical thinking and problem-solving abilities.
• Excellent professional verbal and written communication skills.
• Proficiency in Microsoft Word and spreadsheets.
• Capacity to work independently and within a team, adapting to dynamic environments.
• Demonstrated ability to prioritize tasks, manage heavy workloads, and multitask effectively.

Responsibilities

• Review and prepare pre-authorization letters for accuracy and send them to the requesting provider.
• Provide exemplary customer service by answering calls and voice messages from physician offices, hospitals, and members.
• Accurately enter required information into the pre-authorization system.
• Review structured clinical data and ensure compliance with specified medical terms and codes for final authorization.
• Receive, review, and process incoming pre-authorization requests from providers, facilities, and members.
• Verify member eligibility, plan benefits, and applicable policy guidelines before initiating the authorization process.
• Ensure completeness and accuracy of all clinical documentation required for determination.
• Maintain compliance with HIPAA regulations, applicable laws, and internal policies.
• Adhere to turnaround time requirements for pre-authorization processing as outlined by regulatory bodies and client contracts.
• Document all interactions, determinations, and relevant notes in the utilization management system.
• Assist with audits and quality assurance reviews as needed.

Benefits

• Competitive Hourly Rate + 5% bonus on annual earnings based on company profitability
• Affordable health, vision, and dental insurance for you and your family
• Company contributes up to $2,300 to Health Savings Account annually
• Wellness program that contributes additional money towards your HSA
• Automatic 3% contribution into retirement plan
• Career development and growth opportunities
• 15 days of PTO & 10 paid holidays per year

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed