Prior Authorization Specialist

Summary:

The Prior Authorization Specialist will handle all aspects of prior authorizations and referrals, ensuring timely and accurate processing. This role requires a detail-oriented individual who thrives in a high-volume environment and can manage multiple priorities at once.

Job Description:

Authorization Responsibilities

• Process prior authorizations for medications, specialist referrals, and/or in-house procedures.
• Review and Obtain Referrals and or Authorizations for Office visits
• Manage the daily inbox, ensuring documents are processed promptly.
• Review medical records to confirm insurance requirements are met.
• Submit requests to insurance companies and follow up until completion.
• Follow payer guidelines, HIPAA, and internal policies
• Communicate approval/denial updates to providers, patients, and staff.
• Maintain organized records of all authorization activities.
• Perform basic quality checks on work completed by the team
• Identify process gaps and communicate improvement opportunities
• Collaborate with providers, clinical staff, and billing to ensure accuracy and compliance.

Required Education:

• High School Diploma or GED

Required Experience:

• Minimum 3 years of experience in prior authorizations, referrals, or a related medical office role.
• Knowledge of insurance processes and medical terminology required.
• Experience with Athena required.

Requested Qualifications/Skills:

• Ability to perform efficiently and juggle multiple priorities in a fast-paced, high-volume environment.
• Strong multitasking and organizational skills.
• Strong communication, interpersonal, and problem-solving skills.
• Ability to handle confidential information with discretion and professionalism.
• Team collaboration skills.