Prior Authorization Specialist

Job Summary

To support a growing community-oriented primary care model, the full-time Prior Authorization Specialist will manage the prior authorization process by preparing and submitting requests, coordinating with healthcare providers and insurance companies, and maintaining accurate patient records in a remote work environment.

Key responsibilities

• Prepare and submit detailed pre-authorization requests to insurance payers, ensuring accuracy and compliance with guidelines
• Act as a liaison between healthcare providers, patients, and insurance companies to track authorization status and resolve requests
• Maintain accurate prior authorization records and assist in resolving denials and appeals in a timely manner

Required qualifications

• High school diploma or equivalent required
• 1+ year of prior authorization experience
• Fluency in medical terminology and understanding of major payer guidelines
• Strong organizational skills to manage multiple priorities and workflows
• Ability to maintain accuracy and compliance with HIPAA requirements in a remote environment