Prior Authorization Specialist

Job Description

The Prior Authorization Specialist (Financial Clearance I) at our healthcare client will ensure all required pre-certifications and prior authorizations are obtained for scheduled outpatient services prior to the date of service, in accordance with payer and hospital requirements.

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Skills and Requirements

• High School Diploma or GED Equivalent

• 2+ years of Prior Authorization Verification Experience

• 2+ years of experience in pre-certification initiation in a healthcare/ health office setting

• Prior insurance experience

• Hands-on experience with insurance portals, including:

• Availity, Carelon, Telligent (HMO referrals and authorizations)

• Demonstrates knowledge of Utilization Management Process

• Medicare/Medicaid experience and knowledge

• Clinical knowledge and understanding of medical services

• Epic experience (ask what tools they used)

• Experience supporting HMO and PPO plans

• Tech Savvy - Proficient in Microsoft Office (Teams specifically)

• Excellent communication and verbal skills

• Eagerness to learn and grow within a company, likes overtime, hardworking - Bachelor's degree