Prior Authorization Specialist

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.

Pay: $20.00 - $25.00 per hour

Expected hours: 40.0 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Application Question(s):

• This is a fully on-site position Monday-Friday 8am-5pm, are you able to commit to this?

Ability to Commute:

• Phoenix, AZ 85048 (Required)

Work Location: In person