Prior Authorization Associate

Role Description:

Key Responsibilities

• Prepare and submit prior authorization requests for surgical procedures and related services.
• Review case information to ensure all required documentation is complete and accurate before submission.
• Verify and confirm CPT codes, diagnosis codes, payer requirements, and authorization criteria.
• Submit cases through payer portals, fax, phone, or other required submission methods.
• Follow up with insurance companies to check authorization status, resolve pending issues, and obtain determinations.
• Track all submitted cases and maintain accurate, up-to-date case notes.
• Communicate case status, approvals, denials, requests for additional information, and delays to client practices in a timely and professional manner.
• Coordinate with client practices to obtain missing clinical documentation, updated codes, provider information, or other required details.
• Monitor upcoming surgery dates and prioritize cases based on urgency and payer turnaround times.
• Review payer responses and ensure authorization details match the requested procedure, CPT codes, facility, provider, and date of service when applicable.
• Escalate complex cases, urgent issues, peer-to-peer requests, denials, or documentation concerns as needed.
• Maintain confidentiality of patient information and comply with HIPAA and company policies.
• Support multiple client accounts while meeting productivity, accuracy, and turnaround time expectations.

Qualifications

• Experience with prior authorizations, insurance verification, surgical scheduling, billing, or medical office operations preferred.
• Familiarity with CPT codes, ICD-10 codes, insurance payer guidelines, and medical terminology.
• Ability to work with multiple provider practices, specialties, and insurance plans.
• Strong organizational skills and attention to detail.
• Excellent written and verbal communication skills.
• Ability to manage a high volume of cases and meet deadlines.
• Comfortable using payer portals, EHR/EMR systems, spreadsheets, and case tracking tools.
• Professional, dependable, and able to work independently in a fast-paced environment.

Ideal Candidate