Prior Authorization Specialist

• Build and maintain collaborative relationships with internal and external eligibility and prior authorization stakeholders
• Drive operational performance related to reimbursement and provide direction and oversight of processes affecting cash collections
• Serve as a source of knowledge for the designated revenue cycle function
• Analyze data, identify trends, present opportunity areas and prioritize performance-improvement initiatives
• Establish working relationships with departments affecting revenue cycle performance
• Oversee vendor operations for prior authorization, claims and appeals to ensure timely, accurate processing
• Research, evaluate and interpret eligibility and prior authorization guidance to determine departmental actions
• Coordinate with management regarding trends and issues affecting revenue cycle performance
• Develop goals and metrics linking department and revenue cycle initiatives with organizational strategy
• Develop, manage and monitor implementation and project plans
• Seek technologies that identify and guide improvement opportunities aligned with company success

Eligibility and Prior Authorization Specialist – Temp

• Initiate prior authorization requests with insurance companies by submitting necessary documentation and medical records
• Follow up on prior authorization requests, provide additional information as required, and ensure timely medication approvals
• Communicate prior authorization status and insurance coverage information to patients, support staff, and providers
• Maintain accurate records of prior authorization requests and insurance communications
• Serve as a liaison between providers, patients, and insurance companies to facilitate communication and resolve issues
• Secure patient information and safeguard medical records
• Respond to verbal and electronic requests for information and assistance
• Maintain a safe, secure, and healthy work environment in compliance with legal regulations
• Demonstrate knowledge of emergency procedures and assist in crisis situations
• Maintain client HIPAA rights and confidentiality protections
• Handle documents promptly and accurately for filing and scanning
• Copy, scan, fax, and email information as required
• Complete other relevant responsibilities assigned by the supervisor

• Review and resolve prior authorization inquiries in Salesforce
• Research accounts requiring appeals for prior authorization denials
• Prepare and submit appeals to insurance companies with required medical records, documentation, and justification
• Review and resolve rejected authorizations
• Communicate with healthcare providers and insurance companies to facilitate peer-to-peer review
• Submit and track prior authorization requests using appropriate systems and tools
• Ensure documentation is complete and accurate to avoid authorization delays
• Track appeal outcomes and follow up on unresolved cases
• Collaborate with clinical teams, billing, market access, and insurance representatives
• Provide management with regular updates on authorizations and appeals
• Stay informed about insurance guidelines and payer requirements
• Communicate with internal and external stakeholders
• Perform additional duties as assigned