Prior Authorization Specialist

Job description

About this role

We are seeking a detail-oriented and experienced Prior Authorization Specialist to manage the full lifecycle of prior authorizations (PAs) for medical services. The ideal candidate will be responsible for timely submission, meticulous follow-up, and effective resolution of all prior authorization requests and subsequent appeals. This role is critical in ensuring patients receive necessary services without delay and in maximizing reimbursement for the practice. \n

Responsibilities

• The Prior Authorization Specialist will be responsible for the following
• Prior Authorization Submission and Monitoring:
• Monitor the Prior Authorization queue and manage an organized list of outstanding and in-progress PAs
• Review patient and service data provided by the biller/clinical team for completeness and accuracy
• Submit new prior authorizations to the correct insurance company and plan efficiently via the required method, including insurance portals, fax, or telephone

Qualifications and requirements

• Exceptional Attention to Detail: Crucial for accurately submitting data and preparing appeals.
• Strong Communication Skills: Excellent verbal and written communication skills for professional interaction with insurance representatives and clinical staff
• English Speaking: Fluency in English is required to effectively communicate with insurance representatives and team members.
• Organizational and Time Management Skills: Ability to prioritize a high volume of PA requests and follow-up tasks under deadlines
• Problem-Solving: Resourcefulness in troubleshooting issues with insurance company portals or processes.
• 1840 & Company is recruiting a Prior Authorization Specialist to submit and monitor medical-service authorizations, follow up with insurers, prepare appeals, track approvals and denials, and keep patient-management records accurate and current.