Prior Authorization Specialist

The Prior Authorization Specialist secures insurance approval for medical services, treatments, physical therapy, imaging, EMGs, injections or other related procedures by verifying patient eligibility, collecting clinical info, submitting requests, and tracking approvals or denials with providers and payers to ensure coverage and timely patient care, acting as a key liaison between healthcare teams and insurers.

Essential Responsibilities (Non-Occupational Exposure):
Confirming patient insurance, benefits, and coverage for specific procedures and processing authorizations.
Submission: Preparing and sending authorization requests to insurance companies. Follow up on all requests.
Communication: Liaising with patients, physicians, and payers via phone and system updates.
Documentation: Accurately documenting all communication and case status in databases.
Follow-up: Tracking requests, managing denials, and handling appeals.
Work in collaboration with the Business Office by researching information for denied claims, as needed.
Ensuring adherence to insurance and regulatory guidelines.
Coordinate peer-to-peers with the insurance company and the physician.
Contact patients, as needed, to inform them of the authorization status.
Ensure timely response and initiation of prior authorization requests, consulting patient records and other resources.
Serve as a prior authorization resource to other staff.
Responsible for a variety of administrative functions such as data entry, processing, reporting, and filing.
Special Projects and other duties as assigned.

Location & Commitments:
Onsite position at OFC, 1431 Premier Drive | Mankato, MN 56001
Full-time position M-F 8:00 a.m. 5:00 p.m. with flexibility.
Reliably commute or plan to relocate before starting work.

Basic Requirements:
High school diploma or equivalent, or a minimum of two years of experience in a healthcare, clinical, or hospital.
Experience in medical records, claims, or billing.
Proficiency in Microsoft Office Word, Excel, and Outlook.

Preferred Requirements:
Knowledge of medical terminology, medical insurance filing and insurance appeals.
Experience with insurance authorizations and eligibility.
Knowledgeable in programs such as Availity and insurance websites.

Benefits:
Full-time employees are eligible for comprehensive benefits, including health, dental, vision, disability, and life insurance. They earn Paid Time Off, Extended Illness Time, and Holiday Pay. They are allowed to participate in our 401(k)/profit-sharing plan.

Additionally, OFC believes in creating a fun work environment. We host an annual holiday party, a summer employee event, volunteer opportunities, a Super Bowl auction, various potlucks, and ice cream treats before Memorial and Labor Day weekends.

Equal Opportunity Employer:
This notification confirms the Orthopaedic & Fracture Clinic's commitment to providing equal employment opportunities to all employees and job applicants, in accordance with all applicable federal, state, and local laws, directives, and regulations. The Orthopaedic & Fracture Clinic will consider all applicants for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, or disability status. Upon request, the Orthopaedic & Fracture Clinic will provide entities with a copy of our current Equal Employment Opportunity policy. If you want to receive a copy of our policy or need an accommodation, please email humanresources@ofc-clinic.com or call (507) 386-6785.