Pre-Authorization Specialist

Job Summary

A company is looking for a Pre-Authorization Specialist to manage referral and authorization processes.

Key Responsibilities

• Initiate and manage referral authorizations, including tracking status and responding to inquiries
• Review denied claims for missing authorizations/referrals and process appeals as necessary
• Conduct utilization management medical reviews to ensure compliance with insurance guidelines

Required Qualifications

• High School Diploma / GED
• 2+ years of experience in healthcare, specifically in health plan operations
• Experience in referrals/pre-authorization management and claims billing
• Proficiency with EHR/EMR systems (Epic) and Microsoft Office Suite
• Ability to work full-time with flexibility for shift schedules