Prior Authorization Representative

Prior Authorization Representative Summary Responsible for reviewing scheduled patient services to determine prior authorization requirements and obtaining approvals. Provides support with insurance billing and posting while ensuring compliance with payer contracts, HIPAA, regulatory requirements, and the organization's Code of Conduct. Performs additional duties as assigned. Key Responsibilities Customer Service Deliver professional, courteous service to patients, staff, and external partners Handle inquiries and concerns with discretion, diplomacy, and confidentiality Maintain a positive demeanor in high-pressure situations Authorization & Financial Support Identify services requiring prior authorization and obtain timely approvals Assist with billing, posting, and resolution of unbilled encounters Identify and report billing issues, system errors, or process gaps to management Communication & Teamwork Work collaboratively with clinical staff, payers, and internal departments Communicate issues, data, and updates clearly and in a timely manner Participate in team meetings, training, and process improvement efforts Quality & Compliance Accurately document account activity Ensure compliance with payer rules, HIPAA, and internal policies Assist in updating departmental procedures and training materials as needed Professional Development Complete required training and attend educational opportunities Stay current with payer regulations and authorization requirements Qualifications Education & Experience High School Diploma or GED required Associate's Degree or equivalent coursework preferred Minimum 1 year of healthcare financial services, registration, or related experience Typing speed of 30 WPM or greater preferred Skills & Abilities Strong customer service and communication skills (verbal and written) Ability to prioritize work and make routine independent decisions Basic math and analytical skills Proficiency with Word processing, spreadsheets, patient accounting systems, email, and internet applications All offers contingent upon a post offer physical, urine drug screen, and background check.