Insurance Prior Authorization Specialist

Job Summary

A healthcare company in the insurance industry is seeking an Insurance Prior Authorization Specialist.

Position Responsibilities

• Obtain authorizations and verify medical necessity for chemotherapy, injections/infusions, procedures, diagnostic tests, and radiology services
• Collaborate with providers, prepare documents, and communicate effectively for clinical reviews
• Submit medical records required by payers, for audits, and process appeals

Required Qualifications

• Associate's degree in Health Services Administration or Business related field, or 3 years internal revenue cycle experience in lieu of degree
• Successful completion of Medical Terminology course and Anatomy course
• Knowledge of current third-party payer reimbursement rules
• Advanced keyboard, mouse, computer and Microsoft Office skills
• Subject matter expert in assigned focus area