Prior Authorization SpecialistServ Recruitment Agency • Albuquerque, New Mexico, United States
Prior Authorization Specialist
Serv Recruitment Agency
- Albuquerque, New Mexico, United States
- Albuquerque, New Mexico, United States
À propos
Obtain prior authorizations for clinic-based services, including:
Infusion therapies (chemotherapy, immunotherapy, biologics, and supportive medications) Surgical procedures and related services Oral and specialty medications
Review provider orders, clinical notes, operative plans, and supporting documentation to ensure completeness and payer compliance Submit authorization requests via payer portals, electronic systems, phone, and fax Verify insurance benefits, coverage criteria, and payer-specific requirements, including step therapy, site-of-care rules, and clinical guidelines Track authorization status and proactively follow up with insurance carriers to secure timely determinations Communicate authorization approvals, denials, and pending requirements to providers, nurses, surgery schedulers, pharmacy, and front-desk teams Coordinate peer-to-peer reviews and appeal processes with providers and leadership when authorizations are denied or delayed Ensure authorizations are obtained prior to scheduled clinic visits, infusion appointments, surgeries, or medication dispensing Maintain accurate and up-to-date documentation in the electronic medical record (EMR) and authorization tracking systems Collaborate with billing and coding staff to ensure authorized services align with CPT, HCPCS, ICD-10 codes, and payer requirements Stay current on payer policies, clinic workflows, and regulatory standards impacting outpatient services Maintain compliance with HIPAA, organizational policies, and payer regulations
Required Qualifications
High school diploma or equivalent (Associate's degree preferred) Minimum of 2 years of experience in prior authorization and healthcare revenue cycle. Demonstrated experience with medication and procedural authorizations Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans Proficiency with EMR systems and insurance payer portals Strong organizational skills with the ability to manage multiple authorization requests simultaneously Excellent written and verbal communication skills
Preferred Qualifications
Prior experience in a clinic, outpatient specialty practice, or ambulatory surgery setting Experience with oncology, infusion services, or surgical scheduling Knowledge of oral oncolytics and specialty pharmacy coordination Familiarity with CPT, HCPCS, ICD-10 coding and medical necessity guidelines
Skills & Competencies
High attention to detail and accuracy Strong follow-through and time management skills Ability to work independently while supporting a multidisciplinary clinic team Problem-solving skills with a patient-centered approach Comfort working with time-sensitive and high-priority cases
Work Environment
Specialty practice setting Primarily administrative role with frequent collaboration with clinical and scheduling staff Fast-paced environment requiring prioritization of urgent authorizations for procedures, infusions, and medications
Compétences linguistiques
- English
Avis aux utilisateurs
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