Patient Support - Prior Authorization Specialist

Tribe513; Greenville (SC); On-site; USD 42,000 - 54,000; Full time

Job summary

Tribe 513, located at Pelham Place, is seeking a Prior Authorization Specialist to manage authorizations for surgeries, obstetric care, medications, and imaging. This full-time, on-site role requires initiating PAs when orders are placed or requested, and coordinating with referrals, surgery scheduling, administrative and clinical teams to ensure accuracy and timeliness.

The ideal candidate has at least 1 year in the medical field, excellent interpersonal and written communication, and strong

Qualifications

• High School Diploma or GED is required.
• At least 1 year of experience in the medical field, prior authorizations preferred.
• Excellent interpersonal and written communication skills with a customer-service mindset.
• Strong computer skills and fast typing ability.

Responsibilities

• Initiate, create, and facilitate prior authorization processes for surgeries, medications, and imaging.
• Handle Medicaid pregnancy notifications and Medicaid sterilization consents.
• Respond to patient inquiries via phone regarding authorization status and coordinate with providers as needed.
• Provide updates to patients about PA progress and address questions from patients.
• Perform other duties as assigned and uphold the "Tribe Way" providing authentic, transparent service.
• Promote a patient-centered environment for patients, families, and team members.

Skills

Interpersonal communication

Typing skills

Customer service

Computer skills

Education

High School Diploma or GED

Job description

Job Title: Prior Authorization Specialist
Weekly Hours: Full-Time, 40 hours/week
Supervised by: Manager, Business Operations
Location: Pelham Place, In Person

Overview

Responsible for managing prior authorizations for Parkside OB-GYN, including, surgeries, medications, diagnostic imaging, and obstetric care. Initiating prior authorizations when orders are placed or upon request from specialty offices, pharmacies, or patients. Communicating with patients by phone regarding the status of their authorizations and collaborating closely with the referrals, surgery scheduling, administrative, and clinical teams to ensure all authorizations are completed accurately and efficiently.

Responsibilities

1. Initiating, creating, and facilitating the prior authorization process for surgeries, c-sections, obstetrical care, medications, and diagnostic imaging.

2. Initiating, creating, and facilitating Medicaid pregnancy notifications and Medicaid sterilization consents.

3. Responding to any telephone encounter or patient message requests for prior authorization and communicating with the ordering provider as necessary.

4. Communicating updates regarding PAs with patients as necessary and returning phone calls from patients with questions about their prior authorization.

5. Other duties as assigned.

6. Takes ownership of ensuring the “Tribe Way” is experienced by patients, families, and team members. Promotes an authentic, transparent work environment within all areas.

Required Education & Certifications

• Minimum education requirement: High School Diploma or GED.

• Minimum of 1 year of experience working in the medical field. Experience facilitating prior authorizations preferred.

• Excellent interpersonal and communication (oral and written) skills with customer service focus required.

• Expert computer skills and typing.

Work environment and Physical Demands

Requires sitting, standing, and walking associated with a normal physician office environment. Person may be exposed to fumes, airborne particles, infectious diseases, blood/bodily fluids, and disease-bearing specimens.

Tribe 513 is an Equal Opportunity Employer