Prior Authorization Specialist
Baltimore-MD-21201-United States
JOB SUMMARY:
The Prior Authorization Specialist will act as a liaison between the patients, healthcare providers, and insurance companies, ensuring treatments are authorized and covered. The role will support both the family medicine and specialty practice. The Prior Authorization Specialist supports timely patient access to medically necessary care by coordinating and obtaining insurance authorizations for medications, diagnostic testing, procedures, and durable medical equipment (DME). This role is essential in reducing care delays and ensuring compliance with payer requirements. The specialist serves as a liaison between providers, patients, and insurance companies to ensure accurate and efficient processing of prior authorizations in a busy outpatient setting.
- Contacting insurance companies to initiate prior authorization request.
- Reviewing patient medical records to assess the need for requested treatments or medications.
- Providing supporting documentation to justify the medical necessity of a treatment.
- Following up with insurance companies on the status of prior authorization requests.
- Appealing denied prior authorization requests when clinically appropriate.
- Communicating with patients and providers regarding prior authorization status and potential delays.
- Identifying opportunities to streamline the prior authorization process within the practice.
REQUIREMENTS:
- 1 year of experience required; 3+ years of experience preferred.
- Certified Medical Administrative Assistant and/or Certified Professional Coder preferred.
- Post-secondary education in healthcare administration, medical office management, or a related field preferred with disciplines including health information management, medical billing/coding, healthcare administration, or related areas.
PI273340903
