Prior Authorization Specialist

Location: Raleigh

Hours: Monday - Friday, 8am to 5pm

Pay: $19-$23/hour

Summary:

The Authorization Specialist is responsible for obtaining prior authorizations and pre-certifications for medications, diagnostic procedures, and specialty services. This role ensures timely and accurate processing of authorization requests and supports patient access to care by verifying insurance requirements and benefits when applicable.

Essential functions

Obtain prior authorizations and pre-certifications for medications, diagnostic procedures, and specialty services in a timely and accurate manner.

Verify patient insurance benefits as needed, including services such as nutrition visits, to ensure coverage and identify any authorization requirements.

Accurately document authorization and benefit information in the practice management system and EHR.

Communicate with patients, insurance companies, providers, and pharmacies regarding authorization requirements and status updates.

Maintain current knowledge of payer guidelines, authorization requirements, and policy updates.

Collaborate with clinical and front office staff to ensure timely coordination of patient care.

Cross-train in all functions of the department as requested.

Monitor authorization status and follow up as needed to prevent delays in patient services.

Communicate workflow updates and payer changes to appropriate team members.

Participate in departmental meetings and training as required.

Assist with cross-training and onboarding of new staff as requested.

Perform duties in accordance with organizational policies, procedures, and compliance standards.

Maintain professionalism and provide excellent customer service in all interactions

Required education

High school diploma or equivalent

One (1) year of medical office and EHR experience

Experience with prior authorizations or insurance processes

Preferred education and experience