Prior Authorization Specialist

Description

Job Type: Full-time

Job Overview: Join our medical billing team as an Authorization Specialist. This role includes verifying insurance benefits, obtaining pre-certifications and authorizations from payors, submitting necessary documentation, and assisting patients with understanding their financial obligations. The specialist will monitor the authorization status of scheduled patients and reschedule appointments as necessary pending completed authorization.

Department: Administrative

Reports to: Prior Authorization Manager

Schedule/Type: Full-Time M-F/ Hourly

Overtime Status: Non-exempt

Wage: $20-29.00 per hour, commensurate with experience

• Submit and follow up on authorization requests with insurance companies for internal MRI, therapy, surgery, and DME orders.
• Verify order contents and insurance coverage upon receipt, obtain pre-authorization, and communicate benefits eligibility and financial details to patients and practitioners.
• Notify patients and practitioners of any services requested that are not authorized by insurance.
• Review upcoming schedules for authorization status and contact patients with payment/rescheduling options if authorization is not obtained.
• Utilize intraoffice communication and resources to support the authorization process.
• Prioritize workflow based on authorization time frames, insurance requirements, and urgency.
• Obtain retroactive authorizations as needed.
• Maintain accurate and timely documentation and records for continuity of patient care.
• Perform other duties as assigned.

• High school diploma or GED required. College degree preferred.
• Minimum of 2 years of experience in medical billing/authorization.
• Experience in an orthopedic setting preferred.
• Familiarity with pre-authorization, pre-certification, and health insurance claims processing.

• Knowledge of insurance processes, third-party payers, basic coding (CPT, ICD-9), Medicare compliance, OSHA, HIPAA, and relevant regulations.
• Skills in written and verbal communication, customer service, math, and organization.
• Ability to prioritize tasks, multitask, and work effectively in a fast-paced environment while maintaining cooperative relationships with staff and patients.

• Basic Life/AD&D –Guardian
• 16 days of PTO per year
• 7-7.5 paid holidays per year
• Employee Assistance Program
• 401(k) Safe Harbor Contribution

• Medical
• Health Savings Account
• Dental
• Vision
• Short-Term Disability
• Voluntary Life and AD&D
• Flex Spending Accounts
• General Purpose Healthcare FSA
• Optional Protection Benefits (Accident, Hospital Indemnity, Cancer Care and Critical Illness Insurance)
• 401(k)

Closing Date: January 31st, 2026

We are an Equal Opportunity employer. We encourage diverse candidates to apply and welcome the opportunity to build a talented and inclusive workforce. All qualified individuals are encouraged to apply, regardless of background or identity.

Salary

Description:

$20-29 per hour, commensurate with experience