Prior Authorization Specialist

Job Summary

To enhance the patient financial experience, the full-time remote Prior Authorization Specialist will coordinate pre-authorizations, verify medical necessity, and serve as a point of contact for resolving questions related to prior authorizations.

Key responsibilities

• Utilizes online systems and communication to secure prior authorizations before scheduled appointments and for unscheduled patients
• Verifies medical necessity in accordance with CMS standards and communicates coverage information to providers and patients
• Follows up on prior authorization submissions and denials, assisting with appeals as needed

Required qualifications

• High school diploma or equivalent
• 2 years of clerical experience in healthcare revenue cycle operations, such as billing or patient accounting
• Bilingual strongly preferred, required in some positions
• Knowledge of government and commercial payer benefit and eligibility verification
• Experience working in EPIC is preferred