Clinical Prior Authorization Specialist

Providence Health & Services; Seattle (WA); On-site; USD 49,000 - 74,000; Full time

Benefits offered by this job

Health benefits

Retirement plan

On-site work

Job summary

Providence Swedish is seeking a Prior Authorization Specialist to support processing of medication prior authorizations for clinic patients. You will act as a liaison among physicians, pharmacies, clinic staff and insurance carriers to ensure timely, accurate authorizations.

The role requires 2 years’ experience in a medical/managed care setting; a related Bachelor's degree is preferred. Epic experience is a plus as you work across multiple teams to support patient care.

Qualifications

• 2 years experience in a medical clinic or managed care/health insurance plan within the past 2 years.
• Bachelor's degree in a related field is preferred.

Responsibilities

• Demonstrates proficiency in core functions of prior authorizations, appeals, audits, and training.
• Provides technical assistance to clinic staff and physicians on patient coverage and guidelines.
• Navigates insurer websites to obtain prior authorization requirements and protocols.
• Receives and triages calls from pharmacies and clinics seeking assistance.
• Processes documentation for prior authorizations via fax, portals, and phone.
• Verifies member eligibility as needed and coordinates information with clinics and pharmacies.
• Reviews patient charts to gather documentation showing medical necessity and benefit details.
• Requests additional clinical information from clinics to facilitate medical review.

Skills

Medical clinic experience

Insurance knowledge

Education

Bachelor's degree in related field

Tools

Epic software

Job description

Providence Swedish is seeking a Prior Authorization Specialist to support processing of medication prior authorizations for clinic patients. You will act as a liaison among physicians, pharmacies, clinic staff and insurance carriers to ensure timely, accurate authorizations.

The role requires 2 years’ experience in a medical/managed care setting; a related Bachelor's degree is preferred. Epic experience is a plus as you work across multiple teams to support patient care.