The Prior Authorization Specialist will obtain prior authorizations for surgery, diagnostic imaging, prescription medications, some durable medical equipment, and referral authorizations for some specialist appointments. This position will secure the prior authorization and appropriate parties in the timeliest manner possible so our patient receives the services needed with the least delay.

• Receive request for prior authorizations through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored.
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
• Manage correspondence with insurance companies, physicians, specialist and patients as needed, including documenting in the EHR as appropriate.
• Schedule necessary surgeries, procedures, etc. in a timely manner.
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present.
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.

Job Type: Full-time

Pay: $20.00 - $23.00 per hour

Expected hours: 32 – 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday

Education:

• High school or equivalent (Preferred)

Work Location: In person