Prior Authorization Specalist

Advocare LLC • Marlton, NJ

16d • Onsite

About The Position

A medical prior authorization specialist obtains approval from insurance companies for requested medical services and medications. Key responsibilities include gathering patient and insurance information, submitting requests, tracking their status, and communicating with patients and providers about coverage issues and denials. The role requires attention to detail, strong communication skills, and knowledge of medical terminology and insurance requirements.

Requirements

• A high school diploma is required.
• Knowledge of medical terminology and insurance requirements.
• Strong attention to detail.
• Excellent communication and interpersonal skills, both written and verbal.
• Proficiency with computers and specialized software systems.
• Knowledge of Portals: PEAR, Availity, UHC, UMR, Tricare, Evicore, Carelon, Resmed. Care Orchestrator, CoverMyMeds, ASPN, SureScripts is a must!

Nice To Haves

• Previous experience in insurance authorization is preferred.

Responsibilities

• Initiate and complete prior authorization requests for medical services, procedures, and prescriptions.
• Collect and verify patient demographic, clinical, and insurance information needed to meet reimbursement and approval requirements.
• Contact insurance companies, referring physicians, and patients to gather information, clarify coverage, and resolve issues.
• Maintain accurate records of all communications and track the status of requests and appeals. Monitor schedules for add-on patients to ensure they have the necessary authorization.
• Follow up on denied requests and work to ensure services are approved.
• Verify that services are authorized within the required timeframes and that the process complies with insurance and regulatory requirements.

What This Job Offers

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