Medical Insurance Authorization Specialist

NEUROSCIENCE GROUP; Appleton (WI); On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Health Savings Account

Company-paid Life Insurance

Long-Term Disability Insurance

Voluntary Short-Term Disability

Voluntary Life Insurance

Voluntary Accident and Critical Illess

401(k) with employer contribution

Profit Sharing

Cash Balance Pension Plan

Paid Time Off

Sick Leave Bank

Job summary

Neuroscience Group is seeking a full-time Prior Authorization Specialist to join our Clinical Services team in Northeast Wisconsin. The role focuses on obtaining timely prior authorizations for tests, procedures, and treatments, working with providers, insurers, and patients to remove barriers to care.

Ideal candidates will have prior authorization experience, CPT/ICD-10 coding, strong medical terminology understanding, and proficiency with Epic.

Qualifications

• Experience with medical prior authorization or precertification.
• Working knowledge of commercial insurance, Medicare, Medicaid, and other payers.
• Experience with CPT and ICD-10 coding.
• Epic experience preferred.
• Strong medical terminology understanding.
• Excellent organizational and communication skills.

Responsibilities

• Verify patient insurance coverage and maintain demographic data.
• Review orders, documentation, CPT/ICD-10 codes to determine authorization needs.
• Submit prior authorization requests via payer portals, fax, and phone for tests and procedures.
• Gather and upload clinical documentation from Epic and external records.
• Monitor and follow up on pending authorizations for timely approvals.
• Communicate approvals, denials, and requirements with patients and teams.
• Assist with appeals by gathering docs and submissions.
• Maintain accurate records for continuity of care.
• Collaborate with physicians and staff across departments.

Skills

Prior authorization experience

Medical terminology

CPT/ICD-10 coding

Epic Systems

Excellent communication

Customer service

Teamwork

Tools

Epic Systems

Job description

Description

Prior Authorization Specialist

Join a Team That Keeps Patient Care Moving Forward

Neuroscience Group is growing, and we're excited to expand our Prior Authorization team! We are seeking a full-time Prior Authorization Specialist to join our Clinical Services team. This position works Monday through Friday, 8-hour daytime shifts, with no nights, weekends, or holidays.

As a Prior Authorization Specialist, you'll play a vital role in helping patients receive timely access to the testing, procedures, and treatments they need. Working closely with providers, clinical staff, insurance companies, and patients, you'll ensure prior authorizations are obtained efficiently and accurately while helping remove barriers to care. If you enjoy solving problems, thrive in a fast-paced environment, and take pride in providing exceptional customer service, we'd love to hear from you.

About Neuroscience Group

For more than 30 years, Neuroscience Group has been the region's leader in comprehensive brain, spine, and pain care. As Northeast Wisconsin's only practice bringing together neurosurgery, neurology, orthopedic spine surgery, interventional and non-interventional pain management, and physical therapy, we are committed to improving lives through exceptional patient care.

Today, our team of more than 50 providers serves patients throughout the Fox Valley and Northeast Wisconsin across nine outreach clinics. Everything we do is guided by our core values.

When you join Neuroscience Group, you become part of a collaborative team that is committed to excellence—for our patients and for one another.

What You'll Do

As a Prior Authorization Specialist, you will:

• Verify patient insurance coverage and maintain accurate demographic and insurance information.
• Review provider orders, medical documentation, CPT codes, diagnosis codes, and insurance requirements to determine authorization needs.
• Submit prior authorization requests through payer portals, fax, and telephone for diagnostic testing, procedures, and treatments performed both within Neuroscience Group and at outside facilities.
• Gather and upload supporting clinical documentation from Epic, Care Everywhere, and external medical records.
• Monitor pending authorization requests and proactively follow up to ensure timely approvals.
• Communicate authorization approvals, denials, and insurance requirements with patients, providers, and clinical teams.
• Coordinate peer-to-peer reviews between providers and insurance carriers when required.
• Assist providers with appeals by gathering documentation and supporting appeal submissions.
• Maintain accurate documentation and records to ensure continuity of patient care.
• Manage incoming and outgoing documentation through FaxFinder cloud faxing.
• Collaborate closely with physicians, clinical staff, reimbursement services, outside facilities, and fellow team members.
• Participate in department meetings and continuous process improvement initiatives.
• Perform additional duties as assigned.

What We're Looking For

Successful candidates will have:

• Previous experience with medical prior authorization or precertification.
• Working knowledge of commercial insurance, Medicare, Medicaid, Workers' Compensation, VA, and other third-party payers.
• Experience with CPT and ICD-10 coding.
• Previous Epic experience preferred.
• Strong understanding of medical terminology.
• Excellent organizational skills and exceptional attention to detail.
• Outstanding written and verbal communication skills.
• Strong customer service skills with a patient-first mindset.
• Critical thinking skills and the ability to prioritize multiple tasks in a high-volume environment.
• Proficiency with Microsoft Office and general computer applications.
• The ability to work both independently and collaboratively within a team.
• Physical Requirements
• Primarily seated work with occasional standing, bending, stretching, and reaching.
• Ability to lift supplies weighing up to 20–30 pounds.
• Occasional assistance with wheelchair transfers may be required.
• Ability to operate standard office equipment.
• Sufficient visual acuity, hearing, and manual dexterity to perform essential job functions.

Why Join Neuroscience Group?

We believe outstanding employees deserve outstanding benefits. In addition to a competitive compensation package, we offer:

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Health Savings Account with generous employer contribution
• Company-paid Life Insurance
• Company-paid Long-Term Disability Insurance
• Voluntary Short-Term Disability
• Voluntary Life Insurance
• Voluntary Accident and Critical Illness Insurance
• Competitive compensation based on experience
• 401(k) with guaranteed employer contribution
• Profit Sharing
• Cash Balance Pension Plan
• Generous Paid Time Off
• Separate Sick Leave Bank
• Employee Assistance Program
• Timber Rattlers tickets
• Employee Appreciation Day, Annual Summer Picnic, Holiday Celebration, Years of Service Recognition
• A supportive, collaborative workplace where your contributions make a meaningful difference every day.