Position Summary
The Prior Authorization Specialist is responsible for securing timely insurance authorizations for scheduled and unscheduled healthcare services to ensure reimbursement, regulatory compliance, and continuity of patient care. This role reviews clinical and insurance information communicates with payers and internal stakeholders, and documents authorization approvals accurately in the EHR and billing systems to prevent authorization-related denials.
Required Qualifications
- Must be at least 18 years of age.
- Proof of highest level of education completed but not less than high school education or equivalent.
- High school diploma or equivalent required; associate or bachelor’s degree preferred.
- The ability to build rapport with patients is essential
- Personable, optimistic resilient, and possess exceptional interpersonal communication skills
- Organized and detail oriented.
- Ability to take direction and correction if needed
- Must understand all Insurance Payors and Detailed Contracts
- Verify insurance coverage and eligibility.
- Review of procedure orders and documentation to determine necessity of prior auth.
- Strong communication skills with providers, team members and patients
- Excellent written communication skills
- Detailed documentation of authorization numbers and process for each prior auth
- Collect co-pays and deductibles
- Excellent Customer Service
Preferred Qualifications
- Experience in hospital or multi-specialty practice setting
- Knowledge of CPT, ICD-10, and HCPCS codes
- Familiarity with Medicare, Medicaid, and managed care plans
- Certification such as CPAR, CPC, or CRCR (preferred but not required)