Job Description

Job Description

Job Description

Job Summary: The Medical Prior Authorization Specialist is responsible for obtaining pre-certifications and authorizations for medical procedures, services, and prescriptions. This role works closely with healthcare providers, insurance companies, and patients to ensure timely approvals and reduce treatment delays.

Key Responsibilities:

• Initiate and manage prior authorization requests with insurance providers for medical procedures, medications, and diagnostic services
• Review patient insurance coverage and determine authorization requirements Communicate with insurance companies to follow up on pending authorizations and resolve issues
• Document all authorization activity in the patient’s electronic health record (EHR) Collaborate with physicians, nurses, and other team members to ensure accuracy of clinical documentation
• Provide patients with updates on the status of their authorizations and help them understand their coverage
• Maintain knowledge of payer guidelines and authorization criteria for multiple insurance carriers
• Handle denials and appeals in a timely and professional manner

Qualifications:

• High school diploma or equivalent required; associate degree or certification in medical billing/coding preferred
• 2+ years of experience in prior authorization or medical insurance verification
• Strong understanding of medical terminology, CPT/HCPCS codes, and payer policies
• Proficiency in EMR/EHR systems and Microsoft Office Suite
• Excellent communication, problem-solving, and organizational skills
• Ability to multitask in a high-volume environment with attention to detail

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