Prior Authorization Specialist

Job Summary

To support a growing healthcare team, the full-time Prior Authorization Specialist will determine authorization requirements for outpatient services, submit requests for approval, and follow up with healthcare providers, all while working remotely.

Key responsibilities

• Determine if payer authorization is required for outpatient diagnostic and surgical services using online resources or phone calls
• Submit authorization requests and gather clinical data as needed, escalating cases to physicians when necessary
• Follow client scripting guidelines for patient and physician outreach while ensuring compliance with HIPAA standards

Required qualifications

• High School Diploma or GED equivalent
• Healthcare experience with familiarity in medical terminology
• Knowledge of multiple specialty and prior authorization processes preferred
• Understanding of the revenue cycle process
• Basic computer skills and familiarity with insurance carrier websites