Prior Authorization Associate

Alteva RCM•New York, NY

1d•$60,000 - $75,000

About The Position

The Prior Authorization Specialist manages the prior authorization process for surgical cases on behalf of multiple surgeons, medical practices, and healthcare clients. The role prepares, submits, tracks, and follows up on authorization requests to help ensure accurate and timely processing and that procedures are authorized before their scheduled dates. It serves as a point of contact between Alteva RCM, insurance payers, and client practices, providing regular case-status updates.

Requirements

Familiarity with CPT codes, ICD-10 codes, insurance payer guidelines, and medical terminology.
Ability to work with multiple provider practices, specialties, and insurance plans.
Strong organizational skills and attention to detail.
Excellent written and verbal communication skills.
Ability to manage a high volume of cases and meet deadlines.
Comfort using payer portals, EHR/EMR systems, spreadsheets, and case-tracking tools.
Professional, dependable, and able to work independently in a fast-paced environment.

Nice To Haves

Experience with prior authorizations, insurance verification, surgical scheduling, billing, or medical office operations.

Responsibilities

Prepare and submit prior authorization requests for surgical procedures and related services.
Review case information to ensure required documentation is complete and accurate before submission.
Verify CPT codes, diagnosis codes, payer requirements, and authorization criteria.
Submit cases through payer portals, fax, phone, or other required methods.
Follow up with insurance companies to check authorization status, resolve pending issues, and obtain determinations.
Track submitted cases and maintain accurate, up-to-date case notes.
Communicate case statuses, approvals, denials, requests for additional information, and delays to client practices in a timely and professional manner.
Coordinate with client practices to obtain missing clinical documentation, updated codes, provider information, or other required details.
Monitor upcoming surgery dates and prioritize cases according to urgency and payer turnaround times.
Review payer responses to ensure authorization details match the requested procedure, CPT codes, facility, provider, and date of service when applicable.
Escalate complex cases, urgent issues, peer-to-peer requests, denials, or documentation concerns as needed.
Maintain patient confidentiality and comply with HIPAA and company policies.
Support multiple client accounts while meeting productivity, accuracy, and turnaround-time expectations.