Prior Authorization Specialist

Description

The Prior Authorization Specialist is a key member of the Revenue Cycle team, responsible for obtaining timely insurance authorizations for procedures, diagnostic testing, treatments, and services across multiple specialties. This role ensures compliance with payer requirements, minimizes claim denials, and supports seamless patient access to care at Precision Healthcare Specialists.

Key Responsibilities

• Obtain prior authorizations and referrals for outpatient and inpatient services, procedures, imaging, and treatments
   
• Review provider orders and clinical documentation to ensure accuracy and completeness prior to submission
   
• Submit authorization requests through payer portals, phone, fax, or electronic systems
   
• Track authorization status and follow up with insurance carriers to ensure timely determinations
   
• Communicate authorization approvals, denials, and requests for additional information to clinical and scheduling teams
   
• Verify insurance benefits and coverage requirements related to authorizations
   
• Maintain accurate documentation of authorization activity in the EMR and billing systems
   
• Identify and escalate authorization denials or delays to leadership when appropriate
   
• Stay current on payer-specific guidelines, policies, and medical necessity criteria
   
• Collaborate closely with front desk, clinical staff, billing, and coding teams to support clean claims and reduce denials
   
• Assist with appeals for denied authorizations as needed
   
• Ensure compliance with HIPAA and company policies at all times

Requirements

• High school diploma or equivalent required; associate degree preferred
   
• Minimum 1–2 years of experience in prior authorizations, referrals, or revenue cycle operations (healthcare required)
   
• Strong knowledge of insurance plans, payer requirements, and authorization workflows
   
• Experience working with EMR/EHR systems and payer portals
   
• Familiarity with CPT, ICD-10, and medical terminology preferred
   
• Excellent organizational skills with the ability to manage high volumes and deadlines
   
• Strong communication skills, both verbal and written
   
• Detail-oriented with the ability to multitask in a fast-paced environment
   

Preferred Experience

• Experience in a multi-specialty or physician practice setting
   
• Knowledge of Medicare, Medicaid, and commercial insurance plans
   
• Experience supporting clinical teams across specialties (ENT, Pulmonary, Urology, etc.)
   

Skills & Competencies

• Time management and prioritization
   
• Problem-solving and follow-up skills
   
• Team collaboration
   
• Accuracy and attention to detail
   
• Patient-centered communication
   

Why Precision Healthcare Specialists

• Collaborative, team-oriented environment
   
• Opportunity to work within a growing, multi-specialty organization
   
• Supportive leadership and structured workflows
   
• Focus on quality care and operational excellence