Prior Authorization Specialist

Job Summary

To support efficient healthcare operations, the full-time Prior Authorization Specialist will review and process prior authorization and referral requests for medical services remotely, ensuring compliance with organizational policies and payer requirements while documenting authorization outcomes in the electronic health record.

Key responsibilities

• Review and process prior authorization requests and referrals, ensuring insurance eligibility and medical necessity
• Collaborate with ordering clinicians to submit accurate CPT codes and address authorization concerns with patients
• Update authorization status in the system and respond to inquiries regarding authorization decisions

Required qualifications

• High School Diploma or Equivalent required
• 1-2 years of experience in medical authorization or a related field preferred
• 0-1 year of experience with Epic preferred
• Knowledge of medical terminology and insurance benefits
• Familiarity with computer systems and databases