Prior Auth Specialist

Haven Spine + Pain; Grand Rapids Charter Township (MI); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Haven Spine + Pain in Grand Rapids, MI seeks a dedicated Prior Authorization Specialist to manage all aspects of the prior authorization and precertification process for procedures, tests, and medications. The role combines in-person work with potential remote arrangements as proficiency grows.

You will verify benefits, collect documentation, submit requests, and follow up with payors while maintaining HIPAA compliance and clear patient communications.

Qualifications

• High school diploma or GED required.
• Experience in clinical setting and/or with health insurance carriers preferred.
• Knowledge of HIPAA regulations and patient privacy.
• Strong communication and organizational skills.
• Ability to document workflows and maintain accurate records.

Responsibilities

• Verify insurance eligibility, benefits, and requirements with carriers.
• Request, follow up, and secure prior authorizations before services.
• Communicate with patients about authorization status and timelines.
• Review documentation to ensure compliance with medical policy guidelines.
• Maintain HIPAA-compliant handling of information and efficient documentation.
• Identify trends or issues affecting prior authorizations and relay to team.

Skills

Communication

Organization

HIPAA compliance

Patient communication

Documentation

Education

High School Diploma or GED

Job description

• Location 3333 Evergreen DR NE,STE 100,Grand Rapids, MI, 49525,United States
• Employee Type 1.0 FTE

Description

The Prior Authorization Specialist is responsible for all aspects of the prior authorization and precertification process. Responsibilities include collecting all necessary documentation required for prior authorization for procedures, testing, and medications. Complete timely and accurate identification, submission, and follow up of prior and retro authorization requests to payors. Identify prior authorization trends and/or issues resulting in delayed treatment or claims processing. This position will initially be primarily in-person, with the opportunity to transition to a remote work arrangement overtime, based on business needs and role proficiency.

Essential Job Functions

• Contact insurance carriers to verify patient's insurance eligibility, benefits, and requirements
• Reviews documentation to ensure all medical policy guidelines are met
• Request, follow up, and secure prior authorizations prior to services being performed including appeals if necessary
• Communicates with patients to discuss prior authorization status
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations
• Communicate any insurance changes or trends among team
• Maintains a level of productivity suitable for the department
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
• Other duties as assigned

Job Knowledge/Skills/Abilities

• Excellent verbal and written communication skills
• Effective customer relation skills
• Must be highly organized

Physical Demands:

• Independently mobile to perform tasks
• Ability to be seated for up to 8 hours per shift
• Ability to push, pull, or lift up to 60 pounds

Requirements

• High school Diploma or GED
• Previous experience within a clinical setting and/or with health insurance carriers