Prior Authorization Specialist - Gastroenterology

Job Summary

We are seeking a detail-oriented Prior Authorization Specialist with gastroenterology experience to support our clinical and revenue cycle teams. This role is responsible for obtaining timely insurance authorizations for GI-related procedures, imaging, medications, and treatments to ensure uninterrupted patient care and accurate reimbursement.

• Obtain prior authorizations for gastroenterology procedures, including endoscopies, colonoscopies, biologics, imaging, and specialty medications

• Review provider orders and clinical documentation to ensure medical necessity and payer compliance

• Submit authorization requests through payer portals, phone, and fax

• Track authorization status and follow up with insurance companies to ensure timely approvals

• Communicate authorization outcomes, denials, and requirements to providers, clinical staff, and patients

• Coordinate peer-to-peer reviews and appeals as needed

• Maintain accurate documentation in the EHR and authorization tracking systems

• Stay up to date on payer guidelines, GI-specific policies, and insurance requirements

• Work closely with scheduling and billing teams to prevent delays or claim denials

• High school diploma or equivalent required; associate or bachelor’s degree preferred

• 1+ years of prior authorization experience, preferably in gastroenterology or a specialty practice

• Strong knowledge of insurance plans, CPT/ICD-10 codes, and medical necessity requirements

• Experience with biologics and specialty medications (preferred)

• Familiarity with EHR systems and payer portals

• Strong attention to detail and ability to manage multiple authorizations simultaneously

• Excellent communication and follow-up skills

• Experience with GI procedures and terminology

• Knowledge of Medicare, Medicaid, and commercial insurance plans

• Appeals and denial management experience

• Ability to work independently in a fast-paced clinical environment