Prior Authorization Specialist

Central Maine Healthcare Corporation•Lewiston, ME

2d•$21 - $27

About The Position

The Prior Authorization Specialist works in Patient Financial Clearance and obtains prior authorizations for diagnostic testing and procedures in accordance with payer guidelines. The role involves communicating with insurance companies to obtain approvals, collaborating with provider practices to gather necessary clinical documentation, tracking and following up on pending authorizations to ensure timely completion, and maintaining accurate documentation in the electronic health record.

Requirements

Previous experience in prior authorizations or a related healthcare administrative role.
Effective written and verbal communication skills.
Ability to multitask and prioritize needs to meet required timelines.
Analytical and problem-solving skills.
Customer service experience required.
High school graduate or GED equivalent required.

Nice To Haves

Knowledge of medical terminology preferred.

Responsibilities

Obtain prior authorizations for diagnostic testing and procedures in accordance with payer guidelines.
Communicate with insurance companies to obtain approvals.
Collaborate with provider practices to gather necessary clinical documentation.
Track and follow up on pending authorizations to ensure timely completion.
Maintain accurate documentation in the electronic health record.