Job Description

We are looking for an experienced and detail-oriented **Medical Prior Authorization Specialist** to support a US-based healthcare practice. This role is responsible for securing timely insurance authorizations, ensuring compliance with payer requirements, and minimizing delays in patient care.

✨ Responsibilities

✅ Submit and manage prior authorization requests to commercial, Medicaid, and Medicare payers

✅ Review clinical documentation to ensure medical necessity requirements are met

✅ Follow payer-specific guidelines, policies, and turnaround times

✅ Track authorization status and perform timely follow-ups

✅ Communicate authorization approvals, denials, and requests for additional information

✅ Coordinate with providers, billing, and front-desk teams

✅ Manage peer-to-peer requests and appeal denials when required

✅ Maintain accurate authorization logs and documentation

✅ Ensure compliance with HIPAA and payer regulations

📌 Requirements

✔️ Minimum **2+ years of US prior authorization experience**

✔️ Strong knowledge of commercial insurance, Medicaid, and Medicare processes

✔️ Experience with CPT, ICD-10 codes, and medical necessity criteria

✔️ Familiarity with portals such as Availity, Navinet, Evicore, AIM, and payer-specific portals

✔️ Ability to manage high-volume authorization workloads

✔️ Strong attention to detail and follow-through

✔️ Excellent English communication skills (written & verbal)

Job Tags

Similar Jobs