Prior Authorization Specialist

Western Vascular Institute • Mesa, AZ

1d • Onsite

About The Position

Western Vascular Institute is seeking a full-time Prior Authorization Specialist to join its growing vascular clinic in Mesa, Arizona. This on-site role is responsible for obtaining, managing, and tracking insurance authorizations for surgical procedures, in-office treatments, diagnostic imaging, and other specialty services. The specialist works with physicians, clinical staff, surgery schedulers, insurance providers, and patients to secure accurate and timely approvals and help minimize delays in patient care.

The role involves verifying insurance eligibility, benefits, coverage, and authorization guidelines; preparing and maintaining clinical documentation; monitoring pending requests; and coordinating peer-to-peer reviews, reconsiderations, and appeals. The specialist also maintains authorization records in the electronic medical record and payer portals, resolves authorization barriers, and keeps current with changing payer policies and requirements. Western Vascular Institute values a reliable, positive, detail-oriented team member who is interested in growing with the organization and supporting timely access to vascular care. Additional training may be provided to the right candidate.

Requirements

• Strong understanding of medical terminology, insurance verification, and prior authorization processes.
• Knowledge of Medicare, Medicare Advantage, and commercial insurance plans.
• Proficiency with computers, EMR systems, and insurance payer portals.
• Excellent communication and interpersonal skills.
• Strong organizational and multitasking abilities and keen attention to detail.
• Ability to problem-solve, prioritize deadlines, and work independently or as part of a team.
• Discretion and professionalism when handling confidential patient information.
• Positive attitude, flexibility, and eagerness to learn.

Nice To Haves

• Two or more years of prior authorization experience in a medical practice, surgery center, or hospital.
• Experience with surgical authorizations, specialty procedures, or vascular services.
• NextGen experience.
• Bilingual English/Spanish skills.

Responsibilities

• Obtain, submit, and track prior authorizations for in-office and hospital-based surgical procedures, diagnostic imaging, and other medical services.
• Verify patient insurance eligibility, benefits, coverage requirements, and authorization guidelines.
• Prepare, submit, and maintain clinical documentation required by insurance payers.
• Monitor pending authorizations and follow up with insurance companies to obtain timely approvals.
• Coordinate peer-to-peer reviews, reconsiderations, and appeals for denied or delayed authorization requests.
• Communicate authorization statuses and requirements to physicians, clinical staff, surgery schedulers, and patients.
• Identify and resolve authorization barriers, including missing documentation, coverage limitations, and payer-related issues.
• Maintain accurate, up-to-date authorization records in the EMR system and insurance payer portals.
• Stay informed about changing insurance policies, authorization requirements, and payer guidelines.
• Prioritize authorization requests according to scheduled procedure dates and patient needs.
• Maintain professional relationships with physicians, staff, insurance representatives, and management.

Benefits

• 401(k) with matching
• Health, dental, vision, and life insurance
• Disability insurance
• Paid time off
• Paid sick time
• Supportive and collaborative team environment

What This Job Offers

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