We are seeking a highly organized and detail-oriented Authorization Specialist to oversee and manage the insurance authorization process. The ideal candidate will ensure timely and accurate submission, tracking, and approval of authorizations while maintaining compliance with payer requirements, regulatory standards, and organizational policies.
Experience Required: 1-4 years of experience in Prior Authorization
Key Responsibilities:
- Manage the end-to-end authorization process, including pre-certifications, prior authorizations, and pre-determinations for healthcare services and procedures.
- Review and validate clinical documentation to ensure compliance with payer-specific authorization requirements.
- Collaborate effectively with physicians, clinical staff, insurance carriers, and internal departments to obtain timely approvals.
- Monitor authorization requests, track their status, and proactively follow up with payers to minimize delays, denials, or service interruptions.
- Maintain accurate and up-to-date records of authorization activities within internal systems and databases.
- Identify, investigate, and escalate authorization-related issues, denials, or risks to appropriate stakeholders in a timely manner.