Prior Authorization Specialist

The Orthopaedic & Fracture Clinic, P.A.•Mankato, MN

1d•$19 - $23•Onsite

About The Position

The Prior Authorization Specialist secures insurance approval for medical services, treatments, physical therapy, imaging, EMGs, injections or other related procedures by verifying patient eligibility, collecting clinical info, submitting requests, and tracking approvals or denials with providers and payers to ensure coverage and timely patient care, acting as a key liaison between healthcare teams and insurers.

Requirements

High school diploma or equivalent, or a minimum of two years of experience in a healthcare, clinical, or hospital setting.
Experience in medical records, claims, or billing.
Proficiency in Microsoft Office Word, Excel, and Outlook.

Nice To Haves

Knowledge of medical terminology, medical insurance filing and insurance appeals.
Experience with insurance authorizations and eligibility.
Knowledgeable in programs such as Availity and insurance websites.

Responsibilities

Confirming patient insurance, benefits, and coverage for specific procedures and processing authorizations.
Preparing and sending authorization requests to insurance companies and following up on all requests.
Liaising with patients, physicians, and payers via phone and system updates.
Accurately documenting all communication and case status in databases.
Tracking requests, managing denials, and handling appeals.
Researching information for denied claims in collaboration with the Business Office.
Ensuring adherence to insurance and regulatory guidelines.
Coordinating peer-to-peer discussions with the insurance company and the physician.
Contacting patients to inform them of the authorization status.
Ensuring timely response and initiation of prior authorization requests, consulting patient records and other resources.
Serving as a prior authorization resource to other staff.
Performing administrative functions such as data entry, processing, reporting, and filing.
Assisting with special projects and other duties as assigned.