Acute Care Prior Authorization Specialist

ContinuumRx; Nashville (TN); Presencial; USD 50.000 - 70.000; Jornada completa

Descripción de la vacante

ContinuumRx is seeking an Acute Prior Authorization Specialist to review and process prior authorizations for specialty and acute services. You will collaborate with clinical and administrative teams to ensure timely approvals while maintaining compliance with HIPAA and payer requirements.

Responsibilities include documenting supporting information, following up on pending requests, and safeguarding patient confidentiality.

Formación

• High school diploma or GED required.
• Knowledge of medical terminology preferred.
• Excellent organizational skills.
• Ability to work independently and stay on task.
• Strong verbal and written communication skills.

Responsabilidades

• Review, process, and complete prior authorization requirements for services (PBM authorizations excluded).
• Coordinate with Intake Specialists and Clinical Review Team to identify requests needing Prior Authorization.
• Assist Clinical Review Team to obtain authorizations for specialty and complex therapies.
• Ensure proper supporting documentation and forms are completed for each request.
• Process Prior Authorizations via fax, computer, or phone as required by payers.
• Maintain organized documentation and tracking for all requests.
• Follow up promptly on pending authorizations and denials.
• Document all authorizations, expiration dates, and related information in patient records.

Conocimientos

Medical terminology

Organizational skills

Communication

Independent work

Educación

High School Diploma or GED

Descripción del empleo

ContinuumRx is seeking an Acute Prior Authorization Specialist to review and process prior authorizations for specialty and acute services. You will collaborate with clinical and administrative teams to ensure timely approvals while maintaining compliance with HIPAA and payer requirements.

Responsibilities include documenting supporting information, following up on pending requests, and safeguarding patient confidentiality.