Prior Authorizations Specialist

ALL FULL TIME EMPLOYEES ARE ELIGIBLE FOR A 100% EMPLOYER PAID HELATH PLAN! 

AMERICAN MEDICAL GROUP IS GROWING AND ARE NEEDING SOME ADDITIONAL PRIOR AUTHORIZATION SPECIALISTS

Key Responsibilities

Insurance Authorizations & Verification

• Obtain prior authorizations for GI procedures (e.g., colonoscopies, endoscopies, ERCP, capsule endoscopy) and imaging as required.
• Process authorizations for GI related medications, including biologics and specialty prescriptions.
• Verify insurance benefits, coverage limits, copays, deductibles, and pharmacy benefits.
• Track and monitor authorization status, ensuring approvals are received before scheduled procedures.

Clinical Documentation Support

• Review provider orders and clinical notes to ensure documentation meets insurance requirements.
• Request additional documentation from providers when needed.
• Accurately enter authorization information into the EMR system.

Communication & Coordination

• Communicate authorization outcomes to patients, providers, schedulers, and pharmacies.
• Work closely with the scheduling team to prevent appointment delays.
• Contact insurance companies for updates, clarifications, and peer-to-peer requests.

Administrative Duties

• Maintain detailed logs of pending and completed authorizations.
• Manage denials and initiate appeals when appropriate.
• Ensure compliance with HIPAA and all medical privacy regulations.
• Maintain up to date knowledge of insurance policies, formularies, and GI specific treatment guidelines.

Qualifications

• High school diploma or equivalent.
• Prior experience in medical office operations, insurance verification, or prior authorization preferred
• Knowledge of medical terminology and understanding of GI procedures and medications is desirable
• Strong computer skills; proficiency with EMR systems and authorization portals.
• Excellent written and verbal communication skills.
• High attention to detail and ability to multitask in a fast-paced environment.

Preferred

• Experience working in a Gastroenterology practice or specialty medical office.
• Familiarity with specialty medications (e.g., biologics) and specialty pharmacy processes.
• Certified Medical Assistant (CMA), Certified Professional Biller (CPB), or similar credentials.