Prior Authorization Specialist

Infinx

1d • Remote

About The Position

The Prior Authorization Specialist supports the Patient Access department in various functions, including insurance verification and coordinating prior authorization requests for medical services. This role is critical in facilitating timely patient access to healthcare by managing prior authorization processes. This position involves contacting payers for benefit information, checking authorization requirements, collecting required documentation, submitting requests to payers, and tracking authorization status.

Requirements

• High School Diploma or GED
• Must be able to work from 8am - 5pm Eastern
• 2 years of experience in prior authorizations in either ortho, cardio, or diagnostic imaging
• 5 years of experience in prior authorizations, clinical interpretation, and medical terminology
• 5 years of experience in a clinical setting preferred
• Experience with TPAs (Availity, Carelon, Evicore, UHC) preferred
• Strong computer literacy, including Microsoft Office Suite and EMR/EHR systems
• Ability to read, interpret, and apply medical terminology and clinical documentation
• Ability to multitask and work effectively in a high-volume, fast-paced, and deadline-driven environment
• Strong communication skills with the ability to interact with insurance companies via phone, fax, and electronic portals
• Strong organizational skills and attention to detail
• Ability to maintain confidentiality and follow HIPAA regulations
• Problem-solving ability to investigate denials and determine next steps
• Comfort navigating payer websites and electronic authorization systems
• Certified Medical Assistant preferred

Nice To Haves

• Certified Medical Assistant preferred

Responsibilities

• Contacting payers for eligibility and benefit information to include authorization requirements
• Obtain clinicals necessary to process authorization from specified EMR if required
• Obtain prior authorizations and pre-certifications
• Submit complete and accurate authorization requests
• Follow up and resolve pending authorization requests
• Maintain documentation of authorization activity
• Stay current on payer prior authorization requirements

Benefits

• Access to a 401(k) Retirement Savings Plan.
• Comprehensive Medical, Dental, and Vision Coverage.
• Paid Time Off.
• Paid Holidays.
• Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED