Prior Authorization Specialist

Job Summary

To support a growing healthcare practice, the full-time Prior Authorization Specialist will obtain prior authorizations and pre-certifications for diagnostic testing, medical procedures, and specialty medications while working remotely.

Key Responsibilities

• Obtain prior authorizations and pre-certifications for various diagnostic tests, procedures, and specialty medications
• Verify patient insurance coverage, benefits, and authorization requirements, and submit necessary clinical documentation to insurance carriers
• Monitor authorization requests, communicate outcomes to relevant stakeholders, and assist with appeals for denied authorizations

Required Qualifications

• High school diploma or equivalent required; Associate's degree preferred
• Minimum of 2 years of experience with medical insurance verification, prior authorizations, and pre-certifications
• Knowledge of medical terminology, diagnostic testing, and healthcare insurance processes
• Familiarity with electronic medical record (EMR) systems and insurance payer portals
• Understanding of HIPAA regulations and patient confidentiality requirements