We are seeking experienced and detail-oriented Prior Authorization Specialists with a robust understanding of medical terminology and healthcare insurance processes. The ideal candidate will be responsible for obtaining prior authorizations and referrals from insurance companies, verifying patient insurance eligibility, and coordinating with payers to ensure timely approvals for procedures, surgeries, injections, and DME services.
Key Responsibilities
• Obtain prior authorizations and referrals from insurance companies through payer portals and telephonic communication.
- Verify patient insurance coverage, benefits, and eligibility requirements.
- Review and process authorization requests for procedures, surgeries, injections, and Durable Medical Equipment (DME).
- Provide insurance companies with the necessary clinical documentation to secure approvals.
- Track, monitor, and update authorization statuses, orders, and tasks in the system.
- Follow up with insurance providers on pending authorization requests.
- Maintain accurate records and ensure compliance with payer and organizational Standards.