The Prior Authorization Specialist is a key member of the healthcare team, responsible for obtaining pre-approval from insurance companies for patient medications and treatments. This role helps ensure patients receive needed care without unnecessary delays or financial burden.
Key duties include reviewing physician orders and medical records, verifying patient coverage and benefits, submitting authorization requests through EHR systems and payer portals, coordinating with providers for additional information, tracking authorization status, communicating updates to patients, and handling denial and appeal-related documentation. The role also requires documentation in systems such as EHR, Cover My Meds, and Access Log, as well as timely response to urgent internal messages and voicemail callbacks.
Required Qualifications
- High school diploma or equivalent
- 2+ years of medical office experience in insurance verification and authorization
- Proficiency with electronic health records systems
- Familiarity with medical terminology
- Knowledge of ICD-10 and CPT codes
- Understanding of pharmacy benefit processes
- Strong organizational, communication, and customer service skills
- Ability to multitask, meet deadlines, and work independently or as part of a team
- Basic computer and software proficiency
Preferred
- Medical Assistant certification
Location
Michigan, US
Employment Type
Not specified
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago