Prior Authorizations Specialist

We are seeking an experienced and detail-oriented Prior Authorization Specialist to join our growing team. The ideal candidate will have extensive knowledge of insurance authorization processes across multiple specialties and the ability to manage high-volume requests for several clinic locations.

This role requires a proactive professional who can work independently, communicate effectively with providers and insurance carriers, and ensure timely approvals to support quality patient care.

Responsibilities

• Submit and track prior authorization requests for:
  • GI procedures
  • Pain management services
  • Imaging studies
  • Urology and cardiology services as needed
• Verify insurance eligibility and benefits
• Obtain and document authorizations accurately and efficiently
• Follow up with insurance companies regarding pending, delayed, or denied requests
• Coordinate with physicians, clinical staff, and scheduling teams across multiple locations
• Maintain accurate documentation within the EMR system
• Ensure compliance with payer guidelines and company policies
• Assist with appeals, reconsiderations, and peer-to-peer coordination when necessary
• Prioritize urgent requests while maintaining high accuracy standards
• Utilize insurance and imaging/pre-certification portals to process and manage authorizations, including platforms such as Availity, RadMD, eviCore, Carelon/AIM, and other payer-specific portals