Prior Authorization Specialist

Job Summary

Working remotely in a full-time capacity, the Prior Authorization Specialist will manage telephonic support for online authorization of routine services, monitor patient eligibility, and perform data entry for authorizations and denials.

Key responsibilities

• Serve as the department expert for prior authorizations and establish rapport with various teams to ensure proper service authorization
• Contact providers regarding authorization, denial, and appeals processes while verifying eligibility for continued patient services
• Perform telephonic and online authorization requests, accurately entering required information into applicable systems

Required qualifications

• Experience with Epic and clinical office settings
• Knowledge of Diagnosis Coding, HCPCS, Revenue, and CPT coding
• Ability to work from spreadsheets to determine authorization needs
• Proven experience in managing patient accounts/orders requiring insurance verification and prior authorization
• Commitment to compliance with OSHA, Accreditation Standards, and Corporate Compliance policies