Prior Authorizations Specialist

EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP•Fort Walton Beach, FL

6d•Onsite

About The Position

ALL FULL TIME EMPLOYEES ARE ELIGIBLE FOR A 100% EMPLOYER PAID HELATH PLAN! AMERICAN MEDICAL GROUP IS GROWING AND ARE NEEDING SOME ADDITIONAL PRIOR AUTHORIZATION SPECIALISTS

Requirements

High school diploma or equivalent.
Prior experience in medical office operations, insurance verification, or prior authorization preferred
Knowledge of medical terminology and understanding of GI procedures and medications is desirable
Strong computer skills; proficiency with EMR systems and authorization portals.
Excellent written and verbal communication skills.
High attention to detail and ability to multitask in a fast-paced environment.

Nice To Haves

Experience working in a Gastroenterology practice or specialty medical office.
Familiarity with specialty medications (e.g., biologics) and specialty pharmacy processes.
Certified Medical Assistant (CMA), Certified Professional Biller (CPB), or similar credentials.

Responsibilities

Obtain prior authorizations for GI procedures (e.g., colonoscopies, endoscopies, ERCP, capsule endoscopy) and imaging as required.
Process authorizations for GI related medications, including biologics and specialty prescriptions.
Verify insurance benefits, coverage limits, copays, deductibles, and pharmacy benefits.
Track and monitor authorization status, ensuring approvals are received before scheduled procedures.
Review provider orders and clinical notes to ensure documentation meets insurance requirements.
Request additional documentation from providers when needed.
Accurately enter authorization information into the EMR system.
Communicate authorization outcomes to patients, providers, schedulers, and pharmacies.
Work closely with the scheduling team to prevent appointment delays.
Contact insurance companies for updates, clarifications, and peer-to-peer requests.
Maintain detailed logs of pending and completed authorizations.
Manage denials and initiate appeals when appropriate.
Ensure compliance with HIPAA and all medical privacy regulations.
Maintain up to date knowledge of insurance policies, formularies, and GI specific treatment guidelines.