Prior Authorization Coordinator-Experienced Insurance Authorization Professional | High-Volume, Accuracy-Driven Role
Are you an experienced Prior Authorization Coordinator who knows how to navigate insurance requirements, stay ahead of deadlines, and keep a high-volume workflow moving?
We are looking for a highly organized, detail-oriented Prior Authorization Coordinator to join our team. This is a critical role for someone who understands that accuracy matters.
The ideal candidate has prior hands-on experience obtaining medical insurance authorizations and is comfortable managing a large volume of requests while maintaining a high level of accuracy, urgency, and professionalism.
Insurance authorization experience is required. Experience with ophthalmology or buy and bill injection therapies is a strong plus.
What You'll Do
- Monitor physician schedules and patient appointments to identify services requiring prior authorization.
- Determine authorization requirements for in-office procedures, diagnostic testing, surgeries, injections, and other services based on individual payer guidelines.
- Review medical records and chart documentation to identify the clinical information needed for authorization.
- Interpret and accurately apply CPT, ICD-10, diagnosis, and procedure information when preparing authorization requests.
- Submit complete and accurate prior authorization requests with all required clinical documentation and supporting information.
- Manage a high-volume authorization workload while prioritizing urgent, time-sensitive, and same-day requests.
- Track pending authorizations closely and proactively follow up with insurance carriers to prevent delays.
- Communicate authorization requirements, status updates, and potential issues clearly with physicians, clinical staff, patients, and external facilities.
- Respond quickly to urgent or same-day authorization needs and add-on procedures.
- Manage denied authorizations, including preparing appeals and coordinating peer-to-peer reviews.
- Request and track retroactive authorizations when services have been performed prior to approval.
- Maintain accurate authorization grids, tracking systems, and internal records.
- Work directly with insurance carriers, authorization portals, and external facilities to obtain required approvals.
- Protect patient information and maintain strict compliance with HIPAA and confidentiality requirements.
What We're Looking For
Required:
- Previous experience working with medical insurance prior authorizations
- Strong understanding of insurance authorization requirements and payer processes
- Exceptional attention to detail and commitment to accuracy
- Ability to manage a high volume of work without sacrificing quality
- Strong organizational and time-management skills
- Ability to prioritize multiple requests and meet deadlines
- Experience reviewing medical records and clinical documentation
- Familiarity with CPT and ICD-10 coding
- Excellent written and verbal communication skills
- Computer proficiency, including EMR systems and insurance authorization portals
- Professional, dependable, and courteous communication with providers, staff, patients, and insurance representatives
- High School diploma or GED
Preferred:
- Ophthalmology experience or familiarity with ophthalmic terminology, procedures, and treatment plans
- Experience with buy and bill infusion or injection authorizations
- Medical office, billing, or revenue cycle experience
The Person Who Will Succeed in This Role
You are someone who catches the details others miss. You can work through a demanding authorization queue, keep multiple requests moving, follow up relentlessly, and recognize when something doesn't look right.
You are comfortable working in a fast-paced, high-volume environment where priorities can change quickly. You understand that accuracy and timeliness go hand in hand, and you take ownership of each authorization from submission through approval, denial, appeal, or resolution.
If you thrive on organization, problem-solving, and keeping the wheels turning behind the scenes of patient care, we want to hear from you.
Work Environment
This is an in-office position in a medical office setting and is not eligible for remote or hybrid work.
The position requires extended periods of sitting, computer/data entry, and telephone communication, as well as frequent interaction with clinical staff and third-party payers. Occasional lifting of up to 20 lbs. may be required.
Join a team where your experience, accuracy, and ability to keep a high-volume authorization process moving make a direct impact on patient care.
Equal Employment Opportunity Policy: OEC’s policy is to grant equal employment opportunities to all qualified persons. It is against that policy for any employee to discriminate against an applicant for employment or an employee based on race (including physical characteristics historically associated with race), religion, color, age, sex (including pregnancy), national origin, veteran status, disability, marital status, sexual orientation, gender identity or any other classification protected by applicable federal, state, or local laws. In addition, OEC will not tolerate harassment of any applicant or employee on those bases. The Company will always endeavor to employ the best-qualified applicant for each position. Selection will be based on qualifications, skills, training, experience, past performance, ability to work with the current staff, overall ability to perform the work required, and willingness to display a cooperative attitude toward the organization.
Job Type: Full-time
Pay: $20.00 - $27.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Disability insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Experience:
- Insurance Authorization: 1 year (Required)
Work Location: In person
