Prior Authorization Specialist

Eastern Nephrology Associates • Greenville, NC

23h

About The Position

The Prior Authorization Specialist plays a critical role in ensuring timely and accurate authorization of services, medications, and procedures. This position supports both clinical staff and patients by navigating payer requirements and removing access barriers. The ideal candidate is organized, detail-oriented, and understands the urgency of specialty care approvals, especially in a nephrology setting.

Requirements

• Medical Certification (e.g., CMA, RMA).
• High school diploma or GED required.
• Strong knowledge of insurance plans, prior authorization processes, and medical terminology required.
• Experience with EHR systems and payer portals strongly preferred.
• Working knowledge of nephrology, terminology, procedures, and medications is strongly preferred.
• Experience using electronic health records (EHR), payer portals, and prior auth platforms.
• Understanding of insurance plans, benefits verification, and medical necessity criteria.
• Knowledge of Medical Terminology, CPT codes and ICD-10 codes
• Knowledge of VA and Tricare authorizations
• Minimum of 1 to 2 years of clinical experience
• Professional and respectful communication with patients, coworkers, and external partners.
• Strong organizational skills and attention to detail.
• Ability to work in a fast-paced environment, prioritize tasks, and meet deadlines.
• Maintains professional and positive communication with payers, clients, and other staff.
• Maintains confidentiality of all information regarding clients, families, and employees
• Maintains knowledge regarding new procedures, medications, and health information systems.
• Self-directed and motivated
• Ability to prioritize tasks.
• Excellent communications skills verbally and non-verbal
• Basic computer skills such as Outlook, Word, and Excel

Nice To Haves

• Nephrology or specialty care experience is a plus but not required

Responsibilities

• Verify insurance and determine auth requirements for nephrology services, labs, and prescriptions
• Submit prior auth requests via payer portals, fax, or phone
• Track and follow up on pending authorizations to ensure timely approvals
• Collaborate with providers and staff to gather necessary clinical documentation
• Communicate auth status, denials, or requests to providers and patients
• Appeal denied authorizations with medical necessity support. Peer to Peer interaction
• Document authorizations in the EHR and maintain records for compliance
• Support audits, monitor timelines, and assist in process improvement
• All other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees