Prior Authorization Specialist

Job Summary

A company is looking for a Prior Authorization Specialist.

Key Responsibilities

• Serve as the department expert for prior authorizations and establish effective rapport with various teams
• Contact providers regarding authorization, denial, and appeals processes, while verifying eligibility for services
• Perform telephonic and online authorization requests, ensuring timely completion of patient accounts/orders requiring verification and authorization

Required Qualifications

• Experience in prior authorizations or related healthcare administrative roles
• Knowledge of Diagnosis Coding, HCPCS, Revenue, and CPT coding
• Ability to work collaboratively with clinical and non-clinical departments
• Familiarity with compliance standards and risk management guidelines
• High school diploma or equivalent; relevant certifications may be preferred