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)
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