Prior Authorization Specialist
Green Bay, Brown County, Wisconsin, 54311, USA
Listed on 2026-02-01
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Healthcare
Healthcare Administration, Medical Billing and Coding
Position
Prior Authorization Specialist (#25-609) – Green Bay, Wisconsin
Employment DetailsThis is a full-time, 40-hour per week position in a call center setting with potential for hybrid or fully remote work after one year of training. The role is benefit eligible.
Job SummaryThe Prior-Authorization Specialist at Prevea Health is responsible for obtaining and verifying prior authorizations within appropriate timelines for procedures, diagnostic tests, services, and medications. This role ensures that all requests comply with insurance company policies, guidelines, and healthcare regulations and collaborates with healthcare providers, patients, and insurance representatives to obtain the necessary approvals.
Responsibilities- Identify and obtain requirements for preauthorization of procedures, diagnostic tests, services, and medications.
- See the process through completion to minimize denial of claims.
- Coordinate with department providers, coding/billing staff, and insurance representatives to ensure understanding of information needed for proper authorization.
- Review and interpret insurance coverage and policy guidelines to determine authorization requirements.
- Communicate with patients as needed about coverage and procedures.
- Accurately document and communicate final determinations in the patient’s medical record and to appropriate staff, providers, or patient.
- Work with internal teams to identify and address trends or issues in the prior authorization process.
- Provide feedback and recommendations to improve prior authorization workflows and efficiency.
- High School Diploma and/or GED.
- 1-3 years of experience in a medical or insurance role.
Proficient telephone and computer skills with clear and professional speaking abilities; excellent organizational and communication skills; ability to follow through with internal and external customers; knowledge of insurance and medical terminology; basic knowledge of current CPT/ICD coding.
Equal Employment OpportunityPrevea is an Equal Employment Opportunity/Affirmative Action employer.
Application InstructionsApply online /t/30
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