Prior Authorization Specialist

Job Summary

Detail-oriented and passionate about healthcare, the full-time Prior Authorization Specialist will work remotely to ensure efficient processing of prior authorizations for procedural orders, including obtaining necessary documentation and verifying patient information.

Key responsibilities:

• Obtain prior authorizations for facility and professional charges following departmental protocols
• Submit CPT and HCPCS codes and medical records to insurers to expedite authorizations
• Verify patient demographics and medical details, ensuring HIPAA compliance

Required qualifications:

• 2+ years of experience in a hospital, specialty clinic, or medical billing setting focused on pre-certifications or prior authorizations
• Knowledge of commercial and government insurance requirements, ICD-9/CPT codes, and medical terminology
• Familiarity with Microsoft Office and willingness to learn new software
• Strong English communication skills, both written and verbal
• Understanding of reimbursement and claims procedures and their impact on the revenue cycle