Prior Authorization Specialist

Job Summary

To maximize reimbursement for patients and the organization, the full-time Prior Authorization Specialist will manage authorizations, precertifications, predeterminations, and referrals while working remotely and ensuring timely payer approvals through strong insurance expertise.

Key responsibilities

• Submit medical records and documentation to payers for coverage approval, including network exceptions and single case agreements
• Process authorizations, precertifications, predeterminations, and referrals across multiple health insurance plans
• Educate payers on product features and benefits to support coverage and reimbursement

Required qualifications

• High school diploma required; Associate's or Bachelor's degree preferred
• Minimum 3 years of experience in prior authorization and reimbursement processes
• Background in medical devices, healthcare reimbursement, or a related field
• Strong understanding of insurance processes and authorization workflows
• Proficient in navigating payer portals and Salesforce