The Prior Authorization Specialist plays a critical role in supporting high-quality patient care by ensuring timely insurance verification and authorization for scheduled services. This position serves as a key liaison between patients, physicians, insurance carriers, and hospital departments to facilitate accurate and efficient authorization processes. The ideal candidate possesses strong analytical and organizational skills, a thorough understanding of insurance guidelines and managed care requirements, and a commitment to delivering exceptional customer service. Success in this role requires attention to detail, effective communication, and the ability to manage multiple priorities in a fast-paced healthcare environment while contributing to a positive patient experience.
KNOWLEDGE/EXPERIENCE:
Sufficient experience to demonstrate ability to accept responsibility as a Hospital and Clinic prior authorization representative.
Knowledge of anatomy and physiology, medical terminology and disease processes.
Proficient keyboard skills and working knowledge of computer required.
Good verbal and written communication skills.
Cognitive, organizational and emotional abilities to deal effectively with multiple stressors, deadlines and customer needs.
EDUCATION:
High school Diploma, HiSET or GED equivalent required. Completes Patient Financial Services I and training within first 5 months.