Job Overview We are seeking a dedicated and detail-oriented Prior Authorization Specialist to join our healthcare team. In this vital role, you will be responsible for managing insurance prior authorization requests to ensure timely approval for patient treatments and procedures. Your expertise will help streamline the authorization process, facilitate effective communication with insurance providers, and support clinical teams in delivering quality patient care. This position offers an engaging opportunity to contribute to efficient healthcare delivery while maintaining strict compliance with confidentiality policies and medical coding standards. Responsibilities Review provider orders and medical documentation to determine authorization requirements. Submit prior authorization and pre-certification requests to commercial, Medicare, Medicaid, and managed care insurance plans. Monitor authorization status and follow up with insurance representatives as needed. Obtain, verify, and document approvals, denials, and authorization numbers within the electronic medical record (EMR) and billing systems. Appeal denied authorizations when appropriate. Communicate authorization outcomes and requirements to providers, clinical staff, and patients. Ensure all authorizations are obtained before scheduled services whenever possible. Maintain knowledge of payer-specific policies, guidelines, and authorization requirements. Identify and resolve authorization-related issues that may delay treatment or reimbursement. Track and report authorization metrics, including turnaround times, denials, and appeal outcomes. Assist patients with understanding insurance requirements, out-of-pocket costs, and coverage limitations. Maintain compliance with HIPAA and all applicable federal, state, and organizational regulations. Participate in process improvement initiatives to streamline authorization workflows. Skills Knowledge of insurance verification and prior authorization processes, including working with various insurance providers. Strong understanding of medical terminology, procedures, and coding (CPT/ICD-10). Excellent communication skills, both verbal and written, with the ability to liaise effectively with insurance representatives, healthcare providers, and patients. Detail-oriented with strong organizational and multitasking abilities. Ability to navigate insurance portals and healthcare management systems. Proficient in Microsoft Office Suite (Word, Excel, Outlook) and familiar with Electronic Health Records (EHR) software. Experience with medical billing and coding is a plus. Ability to work independently and as part of a team in a fast-paced environment. Education & Experience High school diploma or equivalent required; Associate's degree or relevant certification preferred. Knowledge of HIPAA regulations and patient confidentiality requirements. 1+ year relevant experience in healthcare administration, insurance verification or prior authorization preferred. Experience in vascular or cardiology strongly preferred.

Pay:

From $23.00 per hour

Benefits:

401(k) Dental insurance Flexible spending account Health insurance Paid time off Vision insurance

Work Location:

In person