Pre-Authorization Specialist

Job Summary

To support patient care, the full-time Pre-Authorization Specialist will identify prior authorization requirements by insurance providers, process and complete prior authorizations for scheduled services, and communicate approval or denial outcomes to the ordering provider's office while working remotely.

Key responsibilities

• Analyze information to complete pre-authorizations based on insurance/payer requirements and ensure correct coverage
• Utilize third-party payer portals to process pre-authorization submissions and document results in Epic
• Advocate for patients and providers by processing pre-authorizations in a timely manner and collaborating with healthcare professionals to secure necessary clinical information

Required qualifications

• Experience with insurance providers and their authorization processes
• Proficiency in using third-party payer portals
• Knowledge of healthcare services and covered benefits
• Ability to document and communicate effectively with healthcare teams
• Experience in identifying trends and challenges related to pre-authorizations