Prior Authorization Specialist

Nutrihealth LLC•Millsboro, DE

20h•$21

About The Position

NutriHealth, a leading outpatient private practice, is actively seeking an experienced and dedicated Prior Authorization Specialist to join our growing team. The Prior Authorization Specialist plays a crucial role by securing necessary approvals from insurance providers for patient medications. Key responsibilities include reviewing clinical documentation, preparing and submitting authorization requests, and coordinating effectively with both healthcare providers and payers to confirm coverage requirements are met. The Specialist is responsible for diligently tracking request status, actively resolving any issues or denials that arise, and maintaining precise records in strict adherence to regulatory and organizational policies.

Requirements

High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration, Nursing, or related field preferred
1–3 years of experience in prior authorization, medical billing, or revenue cycle operations
Proficiency with electronic health records (EHR), practice management software, and insurance portals
Ability to review patient and insurance information accurately and efficiently
Precision in completing authorization forms, documentation, and follow-up activities
Strong verbal and written skills for interacting with providers, payers, and patients
Ability to resolve authorization issues and denials effectively
Understanding of HIPAA, insurance policies, and payer-specific authorization requirements

Responsibilities

Review provider requests to determine the need for prior authorization
Submit and track authorization requests with insurance carriers to ensure timely approvals for prescriptions
Communicate with healthcare providers, insurance representatives, and patients to obtain necessary documentation and clarify coverage requirements
Verify insurance eligibility, benefits, and coverage limitations to prevent claim denials or delays
Maintain accurate records of authorization requests, approvals, denials, and follow-up actions in electronic health systems
Research and resolve authorization denials or discrepancies, coordinating with providers and payers as needed
Educate patients and providers on the authorization process, requirements, and timelines
Monitor authorization trends and provide reports to management to support workflow improvements
Collaborate with billing, clinical, and patient services teams to ensure seamless coordination of care and reimbursement
Stay up-to-date with insurance policies, payer requirements, and industry regulations impacting prior authorizations