Prior Authorization Specialist Jobs

About The Position

Requirements

• Strong understanding of medical terminology, insurance verification, and prior authorization processes.
• Knowledge of Medicare, Medicare Advantage, and commercial insurance plans.
• Proficiency with computers, EMR systems, and insurance payer portals.
• Excellent communication and interpersonal skills.
• Strong organizational and multitasking abilities and keen attention to detail.
• Ability to problem-solve, prioritize deadlines, and work independently or as part of a team.
• Discretion and professionalism when handling confidential patient information.
• Positive attitude, flexibility, and eagerness to learn.

Nice To Haves

• Two or more years of prior authorization experience in a medical practice, surgery center, or hospital.
• Experience with surgical authorizations, specialty procedures, or vascular services.
• NextGen experience.
• Bilingual English/Spanish skills.

Responsibilities

• Obtain, submit, and track prior authorizations for in-office and hospital-based surgical procedures, diagnostic imaging, and other medical services.
• Verify patient insurance eligibility, benefits, coverage requirements, and authorization guidelines.
• Prepare, submit, and maintain clinical documentation required by insurance payers.
• Monitor pending authorizations and follow up with insurance companies to obtain timely approvals.
• Coordinate peer-to-peer reviews, reconsiderations, and appeals for denied or delayed authorization requests.
• Communicate authorization statuses and requirements to physicians, clinical staff, surgery schedulers, and patients.
• Identify and resolve authorization barriers, including missing documentation, coverage limitations, and payer-related issues.
• Maintain accurate, up-to-date authorization records in the EMR system and insurance payer portals.
• Stay informed about changing insurance policies, authorization requirements, and payer guidelines.
• Prioritize authorization requests according to scheduled procedure dates and patient needs.
• Maintain professional relationships with physicians, staff, insurance representatives, and management.

Benefits

• 401(k) with matching
• Health, dental, vision, and life insurance
• Disability insurance
• Paid time off
• Paid sick time
• Supportive and collaborative team environment