About this role
Description
Specific Role:
PRIOR AUTHORIZATION SPECIALIST
Reports to:
Patient Experience Manager
Department:
Operations
Location:
Admin
Occupation:
Medical Administrative Assistant
Salary Range:
$20 - $25/hr, DOE
Schedule:
Full-Time M-F Hours: TBD
Travel:
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.