Prior Authorization Specialist

We are looking for a Prior Authorization Specialist to support front-end revenue cycle activities for a long-term contract opportunity. This position plays an important role in helping patients move through the care process by confirming coverage, securing required approvals, and clarifying financial responsibility before services are delivered. The position requires strong knowledge of insurance processes, prior authorization workflows, and high-volume healthcare operations.

Responsibilities:

• Evaluate scheduled patient services and coverage details to determine when pre-service authorization or other financial clearance steps are required.
• Obtain initial approvals and follow-up authorizations within required timeframes to prevent delays in care or claim issues.
• Verify insurance eligibility, review benefit information, and interpret payer guidelines to support accurate account clearance.
• Calculate and communicate patient financial responsibility estimates based on plan coverage, benefits, and service details.
• Document authorization activity, verification findings, and account updates within EMR or EHR systems, preferably Epic.
• Work across assigned specialty areas such as cardiology, imaging, surgery, or other service lines based on business needs.
• Participate in daily remote team huddles and maintain productivity standards in a fast-paced, metrics-driven environment.
• Provide guidance to newer team members when needed on payer requirements, workflow expectations, and revenue cycle-related issues.
• Support additional work assignments related to financial clearance, insurance review, and pre-service account readiness as needed.