Prior Authorization Specialist | Remote and Nightshift
Job Description
The Surgery Pre-Authorization Specialist (Prior Authorization Specialist) is responsible for obtaining and managing prior authorizations for surgical procedures. This role ensures all required approvals are secured before services are rendered, minimizing claim denials and supporting timely patient care. The specialist works closely with providers, patients, and insurance carriers to verify benefits, submit authorization requests, and maintain accurate documentation.
Key Responsibilities
Obtain prior authorizations for surgical procedures, imaging, and related services in a timely manner.
Verify patient insurance eligibility, benefits, and coverage details.
Review physician orders and clinical documentation to ensure medical necessity requirements.
Submit authorization requests to insurance carriers via portals, phone, or fax.
Follow up on pending authorizations and elevate urgent cases as needed.
Communicate authorization status updates to scheduling teams, providers, and patients.
Maintain accurate and detailed records in the EMR and authorization tracking systems.
Identify and resolve authorization-related issues, including denials and appeals support.
Ensure compliance with payer guidelines, policies, and regulatory requirements.
Collaborate with billing and coding teams to ensure clean claim submission.
Stay current on payer rules, CPT codes, and authorization requirements.
Qualifications
Education & Experience
High school diploma or equivalent required; associate's or bachelor's degree preferred.
2+ years of experience in medical prior authorizations, preferably in surgical or orthopedic settings.
Experience with SOFR or specialty surgical procedures strongly preferred.
Knowledge & Skills
Strong understanding of insurance plans (HMO, PPO, Medicare, Medicaid).
Familiarity with CPT, ICD-10, and HCPCS coding.
Experience with EMR/EHR systems and payer portals.
Excellent communication and organizational skills.
High attention to detail and ability to manage multiple tasks simultaneously.
Ability to work in a fast-paced, deadline-driven environment.
Key Competencies
Problem-solving and critical thinking.
Time management and prioritization.
Patient-focused communication.
Accuracy and compliance awareness.
Team collaboration.
What's in it for you?
Equipment provided.
Competitive salary.
Remote work with small to mid-sized accounting clients in various industries.
Mentorship program supporting career advancement and professional development.
