Medical Prior Authorization Specialist

Leading healthcare organization dedicated to providing exceptional patient care and administrative support services. We are seeking a detail-oriented and experienced Medical Prior Authorization Specialist to join our team and help ensure seamless authorization processes for medical treatments and procedures.

Job Responsibilities:

• Process prior authorization requests for medical procedures, medications, and services in accordance with insurance requirements.

• Verify patient insurance coverage and eligibility for requested services.

• Communicate with healthcare providers, insurance companies, and patients to gather necessary documentation.

• Track and follow up on authorization requests to ensure timely approvals.

• Maintain accurate and detailed records of authorization requests and approvals.

• Identify and resolve issues related to denied authorizations, working with healthcare providers and insurers to appeal decisions as necessary.

• Stay up to date with insurance policies, coverage criteria, and prior authorization guidelines.

• Ensure compliance with HIPAA regulations and company policies.

Qualifications:

• High school diploma or equivalent (Associate’s or Bachelor’s degree preferred).

• Previous experience in medical prior authorization, medical billing, or a related healthcare administrative role.

• Strong understanding of medical terminology, insurance policies, and prior authorization processes.

• Excellent communication and organizational skills.

• Proficiency in electronic medical records (EMR) systems and Microsoft Office Suite.

• Ability to work independently and collaboratively in a fast-paced environment.

• Strong attention to detail and problem-solving skills.

Work Environment:

• This position requires working in the office to collaborate with the team and ensure efficient prior authorization processing.

How to Apply: If you have experience as a prior authorization specialist, we’d love to hear from you! Please submit your resume and your introduction about your tasks and experiences as a prior authorization specialist with the subject line "Medical Prior Authorization Specialist Application."