Prior Authorization Specialist

Job Summary

A company is looking for a Prior Authorization Specialist responsible for obtaining pre-certifications and pre-authorizations for procedures and medications.

Key Responsibilities

• Obtain timely prior authorization or pre-determinations from various insurance plans
• Select and review pertinent medical records and verify patient demographic and insurance information
• Document all prior authorizations follow-ups and maintain confidentiality in accordance with HIPAA regulations

Required Qualifications

• High School Diploma or GED
• 2 years of experience in a physician's office, pharmacy, or healthcare facility
• 2+ years of experience with prior authorization requests for cardiology, oncology, or genetic testing
• Strong computer literacy with experience in EMR/EHR systems
• Ability to read and apply medical terminology and clinical documentation