Prior Authorization Specialist

Job Title:

Prior Authorization/ Medical Receptionist Job Summary:

The Prior Authorization / Medical Receptionist is responsible for coordinating patient scheduling, including appointments, cancellations, and rescheduling based on patient needs. This role involves accurately entering patient information into electronic systems, responding to patient inquiries, and facilitating referrals to medical specialists. Key responsibilities include requesting prior authorizations for same-day and future procedures, verifying medical benefits, and obtaining patient medical records. The position also requires managing and cross-checking information across two electronic medical record (EMR) systems to ensure accuracy. Additionally, the receptionist maintains an organized and welcoming front desk and patient waiting area. The ideal candidate demonstrates strong organizational skills, attention to detail, and a compassionate approach, ensuring efficient practice operations and a positive patient experience. Job Qualifications Education High school diploma or GED required

Experience:

Minimum of 1-2 years of experience in a medical office, healthcare administration, or prior authorization role (preferred) Hands-on experience with insurance verification and prior authorization processes for medical procedures, medications, or services Familiarity with commercial insurance, Medicare, and Medicaid guidelines and payer requirements Experience working with Electronic Medical Record (EMR) systems and scheduling platforms Proven ability to communicate with insurance companies, providers, and patients regarding authorization status and requirements Experience obtaining and reviewing medical records and clinical documentation to support authorization requests Strong understanding of medical terminology, CPT/ICD-10 coding basics , and billing workflows (preferred) Demonstrated ability to manage multiple tasks , meet deadlines, and handle high-volume workloads Experience in a front desk or patient-facing role (preferred but not always required) Knowledge of HIPAA regulations and maintaining patient confidentiality Must be able to work the following schedule: Monday

• Thursday 8:00 am
• 5:00 pm Friday
• 8:00 am
• 12:00 pm

Language:

Bilingual:

English/Spanish, preferred

Additional Requirements/Licenses/Certifications:

Ensure confidentiality, integrity, and availability of all HIPAA (created, received, maintained, or transmitted). Must be able to use proper grammar (reading, writing and in speech). Must have reliable transportation. Ability to display a professional appearance and demeanor. Ability to follow all policies, procedures, standards, specifications, guidelines, actively participate and attend employee meetings and complete required training programs in a timely manner. Ability to promote, work, and act in a manner consistent with the mission of AOPS. Ability to communicate and collaborate with team members to ensure superior results and team success. Demonstrable verbal and written communication skills. Ability to think and act independently to find solutions. Must manage multiple priorities simultaneously. Is task and deadline oriented. Ability to take on ownership of assignments and communicate status, issues, etc., and follow-through to completion. Essential Duties/Responsibilities

DESCRIPTION

Review provider orders and clinical documentation to determine prior authorization requirements Obtain prior authorizations for medical and/or dental procedures, medications, and services in a timely manner Contact insurance companies to verify coverage, benefits, and pre-authorization requirements Submit authorization requests via phone, fax, or payer portals with accurate and complete clinical information Follow up on pending authorizations to ensure timely approvals and avoid delays in patient care Communicate authorization status, denials, and required documentation to providers, clinical staff, and patients Review and interpret insurance policies to determine medical necessity and coverage criteria Manage denied authorizations, including gathering additional documentation and initiating appeals when appropriate Maintain accurate and up-to-date records of authorization requests, approvals, and denials in the system Ensure all patient insurance information is current and correctly documented Coordinate with scheduling and clinical teams to align authorized services with patient appointments Maintain compliance with HIPAA and all regulatory guidelines related to patient information and insurance processes Perform other administrative and support duties as assigned Working Environment and Physical Activities Work is performed in a professional office or healthcare setting Frequent use of computers, phones, and payer portals Requires strong attention to detail, organization, and the ability to manage multiple tasks Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions

Pay:

$17.00

• $22.

00 per hour

Benefits:

Dental insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person