Prior Authorization Specialist

Job Summary

A company is looking for a Prior Authorization Specialist to manage the prior authorization process for procedural orders.

Key Responsibilities:

• Obtain prior authorizations for facility and professional charges following departmental protocols
• Submit CPT and HCPCS codes and medical records to insurers to expedite authorizations
• Verify patient demographics and medical details, ensuring HIPAA compliance

Required Qualifications:

• 2+ years of experience in a hospital, specialty clinic, or medical billing setting focused on pre-certifications or prior authorizations
• Knowledge of commercial and government insurance requirements, ICD-9/CPT codes, and medical terminology
• Familiarity with Microsoft Office and willingness to learn new software
• Associate or Bachelor's degree preferred
• Experience with Meditech is a plus