Healthcare Prior Authorization Navigator

Paycom - ATS; Sterling Heights (MI); On-site; USD 26,000 - 36,000; Full time

Job summary

Paycom - ATS in Sterling Heights, MI is seeking a Prior Authorization Specialist to obtain insurer pre-approvals for medications and treatments. This role blends healthcare knowledge with administrative accuracy and a compassionate approach for patients awaiting critical care.

Responsibilities include reviewing orders, verifying coverage, submitting requests, and tracking authorizations while ensuring HIPAA compliance and timely communication with patients and providers.

Qualifications

• Proficiency in using electronic health records systems.
• Familiarity with medical terminology and ICD-10/CPT codes.
• Strong organizational skills in a fast-paced environment.
• Excellent communication and customer service with empathy.
• Ability to multitask and meet deadlines while maintaining accuracy.

Responsibilities

• Review physician orders and patient records to determine necessity of prior authorization.
• Contact insurers to verify coverage and benefits for prescribed medications and treatments.
• Submit authorization requests through EHR systems, portals, or phone.
• Collaborate with providers to gather additional information for submissions.
• Monitor status of submissions and follow up within 48 hours to resolve delays.

Skills

EHR proficiency

Medical terminology & ICD-10/CPT

Communication skills

Organizational skills

Multitasking under deadlines

Team collaboration

Independent worker

Education

High School Diploma or GED

Medical Assistant Certification (optional)

Tools

Electronic Health Records (EHR) platforms

Job description

Paycom - ATS in Sterling Heights, MI is seeking a Prior Authorization Specialist to obtain insurer pre-approvals for medications and treatments. This role blends healthcare knowledge with administrative accuracy and a compassionate approach for patients awaiting critical care.

Responsibilities include reviewing orders, verifying coverage, submitting requests, and tracking authorizations while ensuring HIPAA compliance and timely communication with patients and providers.