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)
...Degree with a Local Meats & Sheep Reproduction focus Conduct research projects as assigned with a goal of completed thesis and... ...must maintain the appropriate residency status. Teaching assistants whose native language is not English must demonstrate English...
...be able to operate laboratory equipment, computer systems. EXPERIENCE: Relevant experience preferred. NATURE OF SUPERVISION: -... ...and transferring of pediatric and adult patients, usually with assistance. Pushing and pulling up to adult weights may be required....
...take you. Job Summary: Responsible for leading a team and cleaning aircraft interiors, lavatories, restocking supplies. Also... ...of age. Must be able to obtain credentials required as per airport or state or customs requirements. Possess a Valid Driver's License...
...inspires and empowers you to thrive both personally and professionally. Theres no one like you and thats why theres nowhere like RSM. AUDIT ASSOCIATE At RSM, associates work with large and small companies in various industries. They develop strong working relationships...
...It's more than a career, it's a calling WI-SSM Health Hospice House Baraboo Worker Type: Regular Job Highlights:... ...Provides care to patients under the direction of a registered nurse or physician, functioning within the scope of license. Job...