Prior Authorization Specialist

Job Details
Job Location
Eye Surgical Associates - Lincoln, NE
Education Level
High School
Travel Percentage
Negligible
Job Shift
Day
Job Category
Insurance
Description
The Prior Authorization Specialist is responsible for obtaining, tracking, and documenting prior authorizations for medical services and procedures. This role ensures the timely and accurate submission of requests to insurance payers, working closely with providers, clinical staff, and patients to prevent delays in care and secure reimbursement.
Hours: 40 hours per pay period (every 2 weeks), Monday - Friday, 4 hours per day.
Job duties include but are not limited to:

• Review provider orders and patient charts to complete prior authorization
• Gather necessary clinical documentation to support medical necessity.
• Submit prior authorization requests to insurance companies via online portals, fax, or phone.
• Track and follow up on pending authorizations to ensure timely approval.
• Communicate authorization status
• Document all authorization activities accurately in the patient's electronic health record (EHR).
• Work with providers to obtain additional information if requests are denied or require appeal.
• Maintain up-to-date knowledge of payer requirements and authorization processes.
• Assist patients in understanding insurance requirements related to their treatment or procedures.
• Complete patient estimates
• Collaborate with the billing team to prevent claim denials related to authorization.

Requirements

• Previous experience in prior authorization, medical billing, or insurance verification strongly preferred.
• High School graduate or GED equivalent required.
• Knowledge of medical terminology, CPT/HCPCS/ICD-10 coding, and payer guidelines.
• Proficiency with EHR systems and payer authorization portals.