Prior Authorization Specialist

Job Summary

Detail-oriented and organized, the full-time Prior Authorization Specialist I will support healthcare authorization operations remotely by reviewing and processing authorization requests, coordinating with providers and clinical teams, and ensuring compliance with established guidelines.

Key responsibilities

• Review, prioritize, and process incoming prior authorization requests while ensuring compliance with guidelines
• Gather and verify required clinical and administrative information, following up with providers for missing documentation
• Communicate authorization decisions and support the resolution of escalated authorization-related issues

Required qualifications

• Associate degree in Healthcare Administration, Social Work, or a related field, or equivalent experience
• Three or more years of experience in a healthcare administrative or support role
• Experience with healthcare systems and authorization platforms, preferably Jiva or FACETS
• Strong understanding of health plan operations and authorization processes
• Proficiency with Microsoft Office applications and electronic healthcare systems