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.