Prior Authorization Specialist

Functional Medicine of Idaho•Meridian, ID

About The Position

At Functional Medicine of Idaho (FMI), the Prior Authorization Specialist coordinates, obtains, and documents prior authorizations for medical services, procedures, and medications to support timely patient care and accurate reimbursement. The role requires strong communication skills, attention to detail, and the ability to navigate payer requirements efficiently. This full-time position is part of the Billing Department and may also support departmental operations through related duties such as claim follow-up, payment posting, or insurance verification. Functional Medicine of Idaho is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the listed protected grounds.

Requirements

Strong communication skills.
Attention to detail.
Ability to navigate payer requirements efficiently.

Responsibilities

Verify patient insurance coverage and eligibility.
Review provider orders to determine whether prior authorization is required.
Submit prior authorization requests to insurance companies by phone, fax, or payer portals.
Track, follow up on, and document the status of pending authorizations.
Communicate authorization outcomes to providers, clinical staff, and patients.
Collaborate with billing and clinical teams to resolve denials or delays.
Maintain accurate records of authorization activities in the practice.
Ensure compliance with payer policies and HIPAA regulations.
Assist with appeals when authorizations are denied.
Perform other related Billing Department duties, including claim follow-up, payment posting, or insurance verification, to support departmental operations.