Impactful Prior Authorization Specialist | PTO & Medical

OrthoArizona; Chicago (IL); On-site; USD 55,000 - 70,000; Full time

Benefits offered by this job

PTO and holidays

Medical insurance

Health Savings Account

Job summary

OrthoArizona in Peoria, AZ, is seeking a Prior Authorization Specialist to verify insurance requirements and ensure medical necessity documentation is complete for submissions.

You will submit authorizations with correct CPT/diagnosis codes, update EMR notes, and monitor statuses while coordinating with physicians, patients, and payers. The role demands strong communication, organization, and knowledge of health insurance plans.

Qualifications

• Excellent customer / patient service and communication skills.
• Knowledge of medical terminology.
• Ability to promote favorable facility image with physicians, patients, insurance companies and public.
• Understand/perform training on practice management software.
• Minimum of 2 years of experience in healthcare administration or related field.

Responsibilities

• Verify insurance authorization requirements for ordered services/procedures.
• Review documentation or contact the provider to supplement the order and prove medical necessity.
• Submit authorizations with correct CPT and diagnosis codes.
• Cross-reference procedures with doctor’s orders to ensure accuracy.
• Enter authorization numbers and expiration dates into the EMR.
• Update insurance notes in multiple EMR systems for departments to access.
• Monitor and resolve the status of problem authorizations.
• Fax imaging orders to facilities and ensure patient scheduling.
• Maintain medical records per policy.
• Estimate prepay amounts and collect co-insurance, copays, deductibles, or self-pay estimates.

Skills

Customer service

Communication

Problem solving

Telephone communication

Teamwork

Medical terminology

Education

High school diploma or GED

Tools

EMR systems

Practice management software

Job description

OrthoArizona in Peoria, AZ, is seeking a Prior Authorization Specialist to verify insurance requirements and ensure medical necessity documentation is complete for submissions.

You will submit authorizations with correct CPT/diagnosis codes, update EMR notes, and monitor statuses while coordinating with physicians, patients, and payers. The role demands strong communication, organization, and knowledge of health insurance plans.