The Prior Auth specialist would be responsible for managing end-to-end prior authorizations, including reviewing clinical documentation, identifying the correct ICD and CPT codes, submitting requests through payer portals, tracking pending cases, following up proactively, handling denials and appeals when needed, and coordinating closely with schedulers and providers to prevent delays in care.
Key Responsibilities
Review clinical documentation for completeness
Identify correct ICD-10 & CPT codes
Submit requests via payer portals
Track and manage pending cases
Proactively follow up with payers
Handle denials and prepare appeals
Track authorization metrics
Skills Requirements
Minimal coding experience (mostly submission)
Experience reviewing clinical documentation for completeness and accuracy
Experience submitting authorizations through payer portals and following up proactively
Ability to manage pending cases, track metrics, and stay highly organized
Experience handling denials and preparing appeals with supporting documentation