OBGYN Prior Authorization Specialist – Keep Care On Track

Lee Obstetrics and Gynecology; Auburn (AL); On-site; USD 42,000 - 66,000; Full time

Job summary

Lee Obstetrics and Gynecology in Auburn, AL, is seeking a highly organized Prior Authorization Specialist to manage authorizations for obstetric and gynecologic services. You will collaborate with providers, scheduling, and billing staff to secure timely approvals and maintain accurate records.

The role requires knowledge of medical terminology and payer policies, with experience in CPT/ICD-10 coding and multiple payer portals preferred.

Qualifications

• High school diploma or equivalent required.
• Previous experience in medical insurance, prior authorization, medical billing, referrals, or revenue cycle management preferred.
• OBGYN or specialty-practice experience strongly preferred.
• Knowledge of medical terminology required.
• Familiarity with CPT and ICD-10 coding preferred.
• Knowledge of commercial insurance, Medicare, Medicaid, and managed-care plans preferred.
• Experience using insurance payer portals preferred.
• Experience with electronic medical records and practice-management systems preferred.
• Strong attention to detail and accuracy.
• Excellent organizational and time-management skills.
• Ability to prioritize multiple requests and meet strict deadlines.
• Strong written and verbal communication skills.
• Ability to communicate professionally with insurance representatives, patients, providers, and coworkers.
• Ability to work independently while functioning effectively as part of a team.
• Strong problem-solving and follow-up skills.

Responsibilities

• Verify patient insurance eligibility and benefits when necessary.
• Determine whether OBGYN services and procedures require prior authorization.
• Review insurance plans for authorization requirements and payer-specific guidelines.
• Obtain and review necessary clinical documentation from providers and clinical staff.
• Submit prior authorization requests through payer portals, fax, telephone, and any other required methods.
• Obtain authorizations for obstetric and gynecologic procedures, surgical procedures, diagnostic testing, infertility-related services when applicable, in-office procedures, and other services designated by the patient’s insurance plan.
• Track all pending authorization requests and follow up with insurance companies in a timely manner.
• Record authorization numbers, approval dates, expiration dates, approved services, units, and other pertinent information.
• Ensure authorization information is accurately documented in the patient’s account and/or electronic medical record.
• Communicate authorization status with providers, nurses, surgery schedulers, billing staff, and patients as appropriate.
• Notify appropriate staff immediately when an authorization is denied, delayed, or requires additional clinical information.
• Request additional documentation from clinical staff when required by the insurance company.
• Assist with insurance denials, reconsiderations, appeals, and peer-to-peer requests related to prior authorization.
• Monitor authorization expiration dates and obtain extensions or new authorizations when necessary.
• Ensure approved services correspond with the correct procedure, diagnosis, provider, facility, and date of service when applicable.
• Identify authorization-related issues that could result in claim denials or delays in patient care.
• Maintain accurate and organized authorization records.
• Maintain confidentiality and comply with HIPAA and practice policies.
• Stay current with changes to insurance plans, payer requirements, authorization procedures, and OBGYN services.
• Perform other billing and revenue-cycle duties as assigned.
• OBGYN-Specific Responsibilities: develop a strong working knowledge of authorization requirements related to: Gynecology, Office procedures, Ultrasounds and diagnostic testing, Colposcopy and related procedures, Endometrial procedures, Hysteroscopy, D&C procedures, Ablation procedures, Incontinence procedures, Pelvic floor procedures, Gynecologic surgeries, Other procedures requiring payer authorization.

Skills

Insurance Knowledge

Prior Authorization

OBGYN Knowledge

Medical Terminology

CPT/ICD-10

Organization

Attention to Detail

Follow-Up

Communication

Problem Solving

Time Management

Education

High school diploma or equivalent

Job description

Lee Obstetrics and Gynecology in Auburn, AL, is seeking a highly organized Prior Authorization Specialist to manage authorizations for obstetric and gynecologic services. You will collaborate with providers, scheduling, and billing staff to secure timely approvals and maintain accurate records.

The role requires knowledge of medical terminology and payer policies, with experience in CPT/ICD-10 coding and multiple payer portals preferred.