Specialist, Prior Authorization

Lifepoint Health • Somerset, NJ

18h

About The Position

The Prior Authorization Specialist is responsible for obtaining insurance authorizations for medical procedures, diagnostic testing, referrals, medications, and prescribed services to ensure timely patient care and accurate reimbursement. This role serves as a key liaison between providers, patients, and payers, ensuring compliance with payer requirements while supporting clinic operations and revenue cycle efficiency.

Requirements

• High school diploma or equivalent required.
• Minimum of 1–2 years of experience in prior authorizations, medical billing, or revenue cycle operations (healthcare setting preferred).
• Working knowledge of insurance payer requirements, authorization processes, and medical terminology.
• Proficiency with EMR systems and payer portals.
• Strong organizational skills with attention to detail and ability to manage multiple tasks.
• Excellent written and verbal communication skills.
• Ability to work independently and as part of a multidisciplinary team.

Nice To Haves

• Experience in a physician practice or hospital-based clinic environment.
• Familiarity with Medicare, Medicaid, and commercial insurance plans.
• Certification in medical billing/coding or revenue cycle management (CPB, CPC, or similar).
• Experience with authorization appeals and denial resolution.

Responsibilities

• Initiate and manage prior authorization requests for procedures, imaging, referrals, medications, and other services.
• Verify patient insurance eligibility, benefits, and coverage requirements prior to submission.
• Review clinical documentation for completeness and collaborate with providers for medical necessity support.
• Submit authorization requests via payer portals, fax, or phone and track status through completion.
• Communicate approvals, denials, and required follow-up actions to providers, staff, and patients.
• Monitor turnaround times and escalate urgent or delayed cases.
• Follow up on denied authorizations and assist with appeals.
• Maintain accurate documentation in EMR and payer systems.
• Ensure compliance with payer guidelines, regulatory requirements, and organizational policies.
• Collaborate with scheduling, clinical, and billing teams to prevent delays and denials.
• Educate patients, staff, and providers on authorization requirements, payer guidelines, and coverage.
• Ensure all services have required authorizations and update patients on status.
• Coordinate peer-to-peer reviews when required by insurance.
• Notify patients and staff of insurance coverage issues or lapses.
• Assist with scheduling appointments, tests, and procedures as needed.
• Maintain referral and insurance records and enter referrals into systems.
• Maintain knowledge of Medicare, Medicaid, and commercial payer requirements.
• Identify denial trends and recommend process improvements.
• Maintain patient confidentiality in compliance with HIPAA regulations.
• Meet daily productivity and quality standards.

Benefits

• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off / Extended Illness Bank package for full-time employees
• Employee Assistance Program – mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• Professional Development and Growth Opportunities
• And much more…

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees