Prior Authorization Specialist

Description Summary: The Prior Authorization Specialist will handle all aspects of prior authorizations and referrals, ensuring timely and accurate processing. This role requires a detail-oriented individual who thrives in a high-volume environment and can manage multiple priorities at once. Job Description: Authorization Responsibilities Process prior authorizations for medications, specialist referrals, and/or in-house procedures.

Review and Obtain Referrals and or Authorizations for Office visits Manage the daily inbox, ensuring documents are processed promptly. Review medical records to confirm insurance requirements are met. Submit requests to insurance companies and follow up until completion. Follow payer guidelines, HIPAA, and internal policies Communicate approval/denial updates to providers, patients, and staff.

Maintain organized records of all authorization activities. Perform basic quality checks on work completed by the team Identify process gaps and communicate improvement opportunities Collaborate with providers, clinical staff, and billing to ensure accuracy and compliance. Required Education: High School Diploma or GED Required Experience: Minimum 3 years of experience in prior authorizations, referrals, or a related medical office role.

Knowledge of insurance processes and medical terminology required. Experience with Athena required. Requested Qualifications/Skills: Ability to perform efficiently and juggle multiple priorities in a fast-paced, high-volume environment. Strong multitasking and organizational skills. Strong communication, interpersonal, and problem-solving skills.

Ability to handle confidential information with discretion and professionalism. Team collaboration skills.