Prior Authorization Representative Join our healthcare team as a Prior Authorization Representative , where you will play a critical role in ensuring patients receive timely access to medications, diagnostic testing, procedures, and other medically necessary services. Hands-on experience using eClinicalWorks (eCW) is required for this position. The ideal candidate will already be comfortable navigating eClinicalWorks, reviewing clinical documentation, working within patient charts, managing tasks and messages, and supporting prior authorization workflows. This position requires strong knowledge of insurance requirements, medical terminology, prior authorization processes, and clinical documentation. The successful candidate will be organized, persistent, detail-oriented, and comfortable communicating directly with insurance companies, providers, clinical staff, and patients. Responsibilities Review, prepare, submit, and track prior authorization requests for medications, diagnostic testing, procedures, specialty services, and other medical services. Use eClinicalWorks (eCW) daily to review patient charts, provider documentation, diagnoses, medications, orders, referrals, and supporting clinical information. Navigate eClinicalWorks efficiently to locate and organize documentation required for prior authorization submissions. Verify patient insurance eligibility, benefits, coverage requirements, and authorization requirements. Submit prior authorization requests electronically, by payer portal, fax, telephone, or other required methods. Obtain necessary clinical documentation from providers and clinical staff to support medical necessity. Follow up consistently on pending prior authorizations and document authorization status within eClinicalWorks. Communicate with insurance carriers regarding pending requests, additional documentation requirements, denials, peer-to-peer requests, and appeals. Notify providers and appropriate staff of approvals, denials, additional requirements, or authorization delays. Review CPT, HCPCS, and ICD-10 codes to ensure authorization requests contain accurate and appropriate information. Assist with denied authorization requests by identifying the reason for denial and coordinating additional documentation, reconsiderations, or appeals as appropriate. Maintain accurate documentation of all communications and authorization activity within the patient's medical record. Work closely with providers, medical assistants, referral staff, billing staff, pharmacies, and other departments to prevent delays in patient care. Maintain strict compliance with HIPAA and patient confidentiality requirements. Utilize Microsoft Office and other administrative systems for tracking, reporting, and documentation as needed. Required Qualifications Previous hands-on experience using eClinicalWorks (eCW) is required. Previous experience processing prior authorizations in a medical practice or healthcare setting is strongly preferred. Ability to independently navigate patient charts, clinical documentation, orders, tasks, messages, and other workflows within eClinicalWorks. Knowledge of medical terminology, insurance verification, medical billing, and healthcare documentation. Knowledge of commercial insurance, Medicare, Medicaid, and managed care authorization requirements. Familiarity with CPT, HCPCS, and ICD-10 coding. Experience communicating directly with insurance companies and payer representatives. Strong computer skills and proficiency with Microsoft Office applications. Excellent verbal and written communication skills. Strong organizational and time-management abilities. Ability to manage a high volume of authorization requests while maintaining accuracy and appropriate follow-up. Ability to work independently, prioritize urgent requests, and meet established deadlines. Strong attention to detail and documentation. Knowledge of HIPAA and patient confidentiality requirements. Preferred Qualifications Experience completing prior authorizations for both medications and medical services/procedures . Experience working with multiple commercial insurance plans, Medicare, and Medicaid. Experience using payer portals and electronic prior authorization platforms. Experience working in a multi-provider primary care, behavioral health, or specialty medical practice. Experience handling authorization denials, reconsiderations, appeals, and peer-to-peer coordination. What We Are Looking For We are seeking someone who understands that prior authorization requires more than simply submitting a request. The right candidate will actively track outstanding authorizations, follow up with insurance companies, identify missing information, communicate with providers, and take ownership of each request through resolution. Applicants who do not have prior eClinicalWorks experience may not be considered for this position. If you are experienced with eClinicalWorks and medical prior authorizations and thrive in a fast-paced healthcare environment, we encourage you to apply.

Pay:

$18.00 - $20.00 per hour

Benefits:

Dental insurance Employee assistance program Health insurance Paid time off Professional development assistance Vision insurance Wellness program Application Question(s): Do you have at least 1 year of e

ClinicalWorks EHR Work Location:

In person