Prior Authorization Specialist

Job Summary

Working remotely in a full-time capacity, the Prior Authorization Specialist will screen prior authorization requests, coordinate specialized services, and ensure compliance with healthcare delivery standards while managing financial clearance activities.

Key responsibilities

• Prioritizes and processes incoming prior authorization requests, authorizing specified services as per departmental guidelines
• Collaborates with patients, providers, and departments to obtain necessary information and payer permissions prior to scheduled services
• Maintains knowledge of insurance requirements and manages communication with stakeholders to facilitate the financial clearance process

Required qualifications

• High school diploma or GED required; Associate's Degree or higher preferred
• 4-5 years of office experience in a high-volume data entry, customer service call center, or healthcare setting
• Experience with insurance verification, prior authorization, and financial clearance processes
• Knowledge of medical terminology and ICD-9/CPT coding is helpful
• Bilingual candidates are preferred