Prior Authorization

General Summary

The Prior Authorization Specialist coordinates and secures insurance authorization for medications in-office injections and imaging when needed to supporttimelypatient care. This role involves reviewing payer requirements gatheringappropriate clinicaldocumentation and communicating with insurance companies pharmacies andinternalstaff tofacilitateauthorization approvals. The ideal candidatedemonstratesstrong time management attention to detail integrity and the ability to manage multiple requests whilemaintainingorganization and professionalism in a high-volume environment.

Key Responsibilities

• Completeauthorizationsubmissions through electronic platforms payer portals and telephone communications with insurance representatives whenrequired.

• Review patient charts to obtain relevant clinical documentation needed to support authorization requests

• Communicate professionally with insurance companies pharmacies patients and internal staffregardingauthorization requirements and status updates.

• Track and update prior authorization requests and outcomes using internal tracking tools and insurance portals to ensuretimelyprocessing and follow-up.

• Demonstrate accountability for assigned authorization requests bymonitoringstatusandfollowing up with payers when necessary.

• ActivelymonitorPA Pool and EHR inbox communications to ensuretimelyresponse to authorization requests and related inquiries.

• Ensure all prior authorization submissions and supporting documentation accurately reflect the patients medical record andcomply withpayer requirements.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job the employee is occasionally required to stand; walk; sit; use hands to finger handle or feel objects tools or controls; reach with hands and arms; stoop kneel crouch or crawl; and talk or hear. The employee must occasionally lift and/or move more than 45 pounds.

• Familiarity with medical terminology and working knowledge of medical coding systems (CPT ICD-10) relevant to prior authorization requests.

• Strong organizational and time management skills with the ability to prioritize urgent requests and meet deadlines in a high-volume environment.

• Excellent written and verbal communication skills when interacting with patients insurance representatives pharmacies and internal clinical staff.

• Ability to work both independently and collaboratively within a team while managing multiple tasks simultaneously.

• Demonstrates integrity professionalism and ethical decision-making when handling patient information andsubmittingprior authorization requests.

• HS Diploma or GED required.