Prior Authorization Specialist

Triton Medical Solutions

. Review procedure requests to determine required authorizations based on insurance standards .

Posted 11/6/2026full-timeRemote • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in reviewing insurance documentation and authorizations, with a strong understanding of CPT and ICD coding. Capable of providing quality customer service while maintaining confidentiality and adhering to HIPAA regulations.

Highest-signal resume keywords

CPT CodingICD 9/10 CodingMedical Insurance TerminologyCustomer Service SkillsHIPAA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Insurance Documentation ReviewPrior Authorization SubmissionAttention to DetailTyping SkillsComputer Proficiency

Soft Skills

Organizational SkillsCommunication SkillsAbility to Work IndependentlyTeam CollaborationProblem-Solving Skills

Tools & Technologies

Microsoft WordMicrosoft Excel

Industry Keywords

Insurance StandardsMedical NecessityProvider's Office ExperienceEmployee BenefitsConfidentiality

About the role

Key responsibilities & impact

Review procedure requests to determine required authorizations based on insurance standards
Review documentation and contact providers to supplement orders and establish medical necessity
Contact physician offices, customer service departments, and insurance carriers to resolve missing information and obtain prior authorizations
Submit authorizations using correct CPT and diagnosis codes
Review denied prior authorizations and take corrective action
Maintain up-to-date information on insurance companies and relevant changes
Handle incoming and outgoing calls concerning clinical documents and insurance benefits
Provide quality customer service to clients
Work extensively by phone with insurance companies
Collaborate cordially with the team and participate in meetings
Participate in projects and complete other tasks assigned by the Team Leader or management
Maintain confidentiality and adhere to HIPAA guidelines and regulations

Requirements

What you’ll need

High school diploma
1-2 years in a customer service oriented environment preferred
1-2 years working within the insurance industry in a provider’s office, insurance company, or company where involved with employee benefits preferred
Ability to work independently, give attention to detail, prioritize and perform several tasks together without losing concentration
Knowledge of insurance cards, medical insurance terminology, medical benefits, and CPT and ICD 9/10 coding
Ability to follow established procedures
Excellent typing and computer usage skills, including Microsoft Word and Excel proficiency
Good oral and written English communication skills
Well organized and detail-oriented
Own computer meeting the company’s IT requirements

Benefits

Comp & perks

Flexible schedule
Remote work arrangement
Approximately 40 hours per week
Independent Contractor work relationship