We are seeking an experienced and detail-oriented Prior Authorization Specialist to join our growing team. The ideal candidate will have extensive knowledge of insurance authorization processes across multiple specialties and the ability to manage high-volume requests for several clinic locations.
This role requires a proactive professional who can work independently, communicate effectively with providers and insurance carriers, and ensure timely approvals to support quality patient care.
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Submit and track prior authorization requests for:
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GI procedures
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Pain management services
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Imaging studies
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Urology and cardiology services as needed
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Verify insurance eligibility and benefits
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Obtain and document authorizations accurately and efficiently
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Follow up with insurance companies regarding pending, delayed, or denied requests
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Coordinate with physicians, clinical staff, and scheduling teams across multiple locations
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Maintain accurate documentation within the EMR system
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Ensure compliance with payer guidelines and company policies
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Assist with appeals, reconsiderations, and peer-to-peer coordination when necessary
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Prioritize urgent requests while maintaining high accuracy standards
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Utilize insurance and imaging/pre-certification portals to process and manage authorizations, including platforms such as Availity, RadMD, eviCore, Carelon/AIM, and other payer-specific portals
