Prior Authorization Specialist

Job Summary

Detail-oriented and customer-focused, the remote Prior Authorization Specialist will ensure timely and accurate processing of healthcare service requests while collaborating with providers and clinical teams in a contract role.

Key responsibilities

• Review, prioritize, and process prior authorization requests in accordance with established guidelines
• Gather and verify required documentation, communicate with providers regarding missing information, and route complex cases for clinical review
• Respond to provider and member inquiries, verify eligibility and benefits, and assist with navigating authorization processes

Required qualifications

• Associate degree in Healthcare, Social Work, Business, or a related field, or equivalent experience
• Three or more years of experience in healthcare administration or a related healthcare environment
• Experience with healthcare databases, authorization platforms, or electronic health systems preferred
• Proven ability to manage competing priorities and maintain a high level of accuracy in a high-volume setting
• Strong customer service skills with the ability to interact professionally with providers and members