Prior Authorization Specialist

Prior Authorization Specialist

Location: Private Medical Practice
Employment Type: Full-Time (or Part-Time, if applicable)

Job Summary

We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our private medical practice. The ideal candidate will be responsible for obtaining insurance prior authorizations, ensuring timely approvals for patient services, and working closely with providers, insurance companies, and patients to minimize delays in care.

Responsibilities

• Submit and track prior authorization requests with commercial insurance plans, Medicare, and Medicaid.
• Verify patient insurance eligibility and benefits.
• Follow up with insurance companies regarding pending authorizations and appeals.
• Communicate authorization status with providers, clinical staff, and patients.
• Review medical documentation to ensure it supports authorization requests.
• Maintain accurate records in the Epic electronic medical record (EMR) system.
• Assist with denied claims by gathering supporting documentation and initiating appeals.
• Stay current with payer guidelines and authorization requirements.
• Maintain confidentiality and comply with HIPAA regulations.

Required Qualifications

• Minimum of 2 years of prior authorization experience in a physician practice or healthcare setting.
• Hands-on experience using the Epic EMR system is required. Candidates without Epic experience will not be considered.
• Knowledge of CPT, ICD-10, HCPCS, and medical terminology.
• Strong understanding of commercial insurance, Medicare, and Medicaid prior authorization processes.
• Excellent organizational, communication, and problem-solving skills.
• Ability to manage multiple priorities while maintaining accuracy and meeting deadlines.
• Proficiency with Microsoft Office and standard healthcare software.
• Commitment to maintaining HIPAA compliance and patient confidentiality.

Benefits

• Competitive pay based on experience
• Paid time off
• Opportunities for professional growth
• Supportive team environment

How to Apply

Please submit your resume along with a summary of your prior authorization experience and your experience using the Epic EMR system. Only applicants meeting the required qualifications, including Epic experience, will be considered.

Pay: $23.71 - $28.56 per hour

Work Location: In person