Prior Authorization Specialist

Position Summary

We are seeking a detail-oriented Prior Authorization Specialist to support our Beaver Dam medical office. This role is responsible for insurance verification, eligibility and benefit checks, securing prior authorizations across multiple payers, and communicating patient financial responsibility clearly and professionally. Accuracy, follow-through, and adherence to payer guidelines are essential to success in this position.

Key Responsibilities

Insurance & Eligibility

• Verify patient insurance coverage, eligibility, and benefits prior to services
• Accurately enter and maintain insurance information in the practice management system
• Identify deductible, coinsurance, copay, and authorization requirements

Prior Authorizations

• Obtain prior authorizations for medical procedures, imaging, DME, sleep studies, and office-based services
• Navigate payer portals and phone systems (commercial, Medicare Advantage, Medicaid, etc.)
• Ensure authorization requests meet payer-specific clinical guidelines and medical necessity requirements
• Track, follow up on, and resolve pending or delayed authorization requests
• Communicate approval, denial, or additional documentation needs to appropriate staff

Documentation & Compliance

• Maintain complete and accurate documentation of authorization requests, approvals, denials, and reference numbers
• Ensure documentation complies with payer requirements and internal policies
• Support audit readiness through consistent and thorough recordkeeping

Patient Communication

• Contact patients by phone to explain insurance benefits, deductible amounts, and anticipated out-of-pocket costs
• Communicate financial responsibility clearly, professionally, and compassionately
• Respond to patient questions regarding authorization status and insurance coverage

Team Collaboration

• Work closely with providers, scheduling, billing, and clinical teams
• Identify payer trends, delays, or recurring issues and report them to management
• Support efficient scheduling by ensuring authorizations are completed prior to services

Qualifications

Required

• Prior experience with medical prior authorizations, insurance verification, or revenue cycle processes
• Working knowledge of insurance terminology and payer requirements
• Strong attention to detail and documentation accuracy
• Professional phone communication and patient interaction skills
• Ability to manage multiple authorizations and deadlines independently

Preferred

• Experience in ENT, sleep medicine, DME, or specialty medical practices
• Familiarity with EMR and practice management systems
• Experience working with commercial, Medicare, and Medicaid payers

Schedule & Work Environment

• 32 hours per week
• In-office position at our Beaver Dam, Wisconsin location
• Consistent attendance and timely completion of authorization requests are required

Job Types: Full-time, Part-time

Expected hours: 25 – 32 per week

Benefits:

• 401(k)
• Employee discount
• Flexible schedule
• Paid time off

Work Location: In person