Healthcare Prior Authorization Specialist

highmarkhealth; Pennsylvania; Hybrid; USD 27,000 - 40,000; Full time

Job summary

Highmark Health is seeking a Healthcare Payer Authorization Associate to ensure prior authorizations are obtained from third-party payers and to verify patient insurance information. You will collaborate with care teams to gather required data and maintain EMR records with precision.

The role requires HIPAA compliance, strong communication, and the ability to multitask in a fast-paced environment while supporting appeals for authorization denials and ensuring data integrity across systems.

Qualifications

• Associate's Degree in Healthcare or Business Administration OR 3 years in healthcare.
• 1 year with medical terminology and healthcare insurance processes.
• Excellent communication and customer service skills.
• Proficiency in using healthcare information systems.
• Ability to prioritize and multitask.
• Maintains professional tone with patients and payer representatives.
• Critical problem solving skills.
• Experience within financial clearance setting.
• Strong attention to detail.

Responsibilities

• Obtains prior authorizations from third-party payers.
• Verifies patient's insurance and benefits information.
• Complies with HIPAA and privacy policies.
• Gathers clinical information required by the payer to authorize services.
• Supports denial appeals with the business office.
• Maintains accurate authorization records in the EMR.
• Contacts patients to collect demographic and insurance information.
• Identifies patients needing Medicare ABNs.
• Performs other registration duties as requested.

Skills

communication

customer service

prioritization

multitasking

HIPAA compliance

attention to detail

problem solving

healthcare IT systems

data entry accuracy

Education

Associate's Degree in Healthcare or Business Administration OR 3 years experience

Tools

EMR systems

Job description

Highmark Health is seeking a Healthcare Payer Authorization Associate to ensure prior authorizations are obtained from third-party payers and to verify patient insurance information. You will collaborate with care teams to gather required data and maintain EMR records with precision.

The role requires HIPAA compliance, strong communication, and the ability to multitask in a fast-paced environment while supporting appeals for authorization denials and ensuring data integrity across systems.