Prior Authorization Specialist

Job Summary

Working remotely on a part-time basis, the Prior Authorization Specialist will perform advanced prior authorization and referral activities, manage complex cases, and ensure compliance with insurance eligibility and medical necessity while maintaining an individual workload.

Key responsibilities

• Secure insurance authorizations by collecting and entering required information for precertification of procedures, tests, and imaging
• Collaborate with ordering clinicians to ensure accurate CPT codes are submitted for prior authorization or referrals
• Independently manage complex, high-dollar, or time-sensitive authorization cases and assist with onboarding and training of new staff

Required qualifications

• High School Diploma or Equivalent required
• 2-3 years of experience in medical authorization or a related field
• 0-1 year of Epic experience preferred
• Knowledge of medical terminology and insurance benefits, including coordination of benefits
• Familiarity with computer systems and databases