A specialty medical practice in the Central Virginia area is looking for an experienced Prior Authorization Specialist to support our clinical and administrative teams. This position plays a key role in helping patients access recommended procedures and treatments by managing insurance approvals and benefit verification.
The ideal candidate is organized, detail-focused, and comfortable working in a fast-paced healthcare setting with multiple priorities throughout the day.
Primary Duties:
- Obtain and verify insurance eligibility and benefits for patient visits and procedures
- Coordinate authorization requests with commercial insurance carriers and specialty review organizations
- Review provider documentation to ensure medical necessity requirements are met prior to submission
- Monitor pending authorizations and follow up on delayed, denied, or incomplete requests
- Communicate authorization updates with providers, clinical staff, and patients
- Maintain accurate records within the electronic medical record and scheduling systems
- Assist with appeals and additional documentation requests when necessary
- Support front office operations and other administrative tasks as assigned
Preferred Qualifications:
- Previous experience with insurance authorizations in a medical office setting
- Familiarity with CPT and ICD-10 coding, insurance portals, and payer guidelines
- Experience working with platforms such as Availity, Cohere, Evicore, or similar authorization systems
- Strong written and verbal communication skills
- Ability to prioritize tasks independently and meet deadlines
- Comfortable interacting with patients, providers, and insurance representatives professionally
Education & Experience:
- High school diploma or equivalent required
- Additional healthcare administration training or coursework preferred
- At least 2 years of experience in medical authorizations, referrals, billing, or insurance verification preferred
- Specialty practice experience is a plus
Job Type: Full-time
Pay: $18.50 - $21.50 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
Experience:
- Insurance verification: 2 years (Preferred)
Ability to Relocate:
- Richmond, VA 23236: Relocate before starting work (Required)
Work Location: In person
