Top 15 Prior authorization specialist Jobs in Pleasant Prairie, Wi

Prior Authorization/Referral Specialist
Froedtert South, Inc. —Pleasant Prairie, WI
- $17.00 - $25.25 an hour
- Part-time
- Microsoft Excel
- Microsoft Outlook
- Customer service
- 403(b) matching
- Health insurance
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Patient Access Specialist - Imaging
Froedtert South, Inc. —Pleasant Prairie, WI
- $17.00 - $25.25 an hour
- Full-time
- Computer literacy
- High school diploma or GED
- Medical terminology
- 403(b) matching
- Health insurance
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Patient Access Specialist Imaging
Froedtert South, Inc. —Pleasant Prairie, WI
- Full-time
- Computer literacy
- High school diploma or GED
- Medical terminology
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Patient Access Specialist - Clinic
Froedtert South, Inc. —Pleasant Prairie, WI
- Full-time
- Computer literacy
- High school diploma or GED
- Clinic
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Patient Access Specialist
Froedtert South, Inc. —Kenosha, WI
- $17.00 - $25.25 an hour
- Full-time
- Computer literacy
- High school diploma or GED
- Medical terminology
- 403(b) matching
- Health insurance
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Specialist, Access and Reimbursement
AbbVie —North Chicago, IL
- $65,500 - $125,500 a year
- Full-time
- Hybrid work
- Mid-level
- 3 years
- Continuous improvement
- Paid holidays
- Health insurance
Referral Coordinator
AHS Vista LLC —Waukegan, IL
- $20 - $26 an hour
- Full-time
- Customer service
- HIPAA
- Mid-level
- Dental insurance
- 401(k)
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Scheduling Specialist
RAYUS Radiology —Oak Creek, WI
- Weekends as needed
- Bilingual
- Computer literacy
- High school diploma or GED
- Paid holidays
- Disability insurance
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Prior Authorization/Referral Specialist

Froedtert South, Inc. -
Pleasant Prairie, WI

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Job Details

Part-time
$17.00 - $25.25 an hour

Benefits

403(b) matching
Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Vision insurance
Employee discount
403(b)

Qualifications

Customer communication
Microsoft Excel
Microsoft Outlook
Customer service
Word embeddings
High school diploma or GED
Documentation tools
Patient interaction
Medical terminology

Full Job Description

POSITION PURPOSE
- The Prior-Authorization/Referral Specialist plays a key role in supporting patient access to care by verifying insurance eligibility and benefits, and securing required pre-certifications, authorizations, and referrals for both facility and professional services. This position ensures timely and accurate communication with payors and healthcare providers, obtains necessary clinical documentation to support medical necessity, and maintains detailed records throughout the authorization process.
MINIMUM EDUCATION REQUIRED
- High School or GED
MINIMUM EXPERIENCE REQUIRED
- One (1) year of insurance/prior authorization experience (preferred)
- Experience and familiarity with using insurance portals
LICENSES / CERTIFICATIONS REQUIRED
- None
KNOWLEDGE, SKILLS & ABILITIES REQUIRED
- Strong customer service orientation with excellent interpersonal and computer skills.
- Working knowledge of medical terminology and healthcare documentation standards.
- Demonstrated ability to manage time effectively, prioritize tasks, and maintain accuracy in a high-volume environment.
- Proficient with internet-based tools, email communication, and Microsoft Office applications (e.g., Word, Excel, Outlook).
- Strong written and verbal communication skills, with the ability to interact professionally with patients, clinicians, and insurance representatives.
- Proven experience in prior authorizations, referrals, patient registration, insurance verification, and understanding of various health insurance plans (preferred).
- Proficient in navigating online prior authorization portals and working with multiple commercial and government payors (preferred).
- Knowledge of medical coding systems, including ICD-10, CPT, and HCPCS codes (preferred).
PRINCIPLE ACCOUNTABILITIES AND ESSENTIAL DUTIES
- Verify insurance eligibility and benefits for scheduled services to determine prior-authorization or referral requirements.
- Initiate and follow through on prior-authorization and referral requests with payors, ensuring timely approvals.
- Collect and submit required clinical documentation to support medical necessity and facilitate authorization.
- Document all authorization activities accurately in the electronic health record (EHR) and/or designated tracking systems.
- Communicate authorization status and requirements clearly to providers, clinical staff, and patients as needed.
- Coordinate with providers and clinical teams to obtain additional information or clarification required by payors.
- Maintain up-to-date knowledge of payer policies, coding guidelines (ICD-10, CPT, HCPCS), and authorization processes.
- Ensure timely resolution of authorization-related issues to prevent delays or denials in patient care or billing.
- Provide exceptional customer service when interacting with internal teams, external payors, and patients.
- Participate in continuous quality improvement efforts, including audits, training, and performance reviews.
  
  Salary Range: $17.00 to $25.25/hr (based on experience)
  Benefits:
  
  Medical, dental and vision benefits available
  403(b) company match available
  Tuition reimbursement
  Employee discount program
  Competitive PTO

Location: Froedtert South, Inc. · PATIENT ACCESS
Schedule: Regular Part-Time, Days, 40

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Refine Your Search

prior authorization specialist jobs in pleasant prairie, wi

Prior Authorization/Referral Specialist

Patient Access Specialist - Imaging

Patient Access Specialist Imaging

Patient Access Specialist - Clinic

Patient Access Specialist

Specialist, Access and Reimbursement

Referral Coordinator

Scheduling Specialist

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