Prior Authorization & Benefits Specialist

New Mexico Orthopaedic Associates P C; Albuquerque (NM); On-site; USD 36,000 - 48,000; Full time

Job summary

New Mexico Orthopaedic Associates P C in Albuquerque, NM is seeking a Benefits Verification and Prior Authorization Specialist to support providers with timely benefits checks and approvals. The role requires accuracy in demographic data, credentialing review, and coordination with clinic teams.

Responsibilities include obtaining referrals, managing authorizations for procedures and DME, and maintaining compliant patient records.

Qualifications

• High School Diploma or GED with two years of relevant experience.
• Pre-verification and Prior Authorization experience in a medical office setting preferred.
• Ability to read, write and speak English; Spanish preferred.
• Ability to establish and maintain effective working relationships with staff, patients and vendors.

Responsibilities

• Verify eligibility of benefits and prior authorizations for all physicians and therapists.
• Update patient demographics as needed and review credentialing for accuracy and contract information.
• Verify referrals if needed and obtain referrals from PCP.
• Obtain eligibility and prior authorizations for DME, surgeries and outside testing and physical therapy.
• Coordinate with Front Office, Medical Records, Medical Assistants and Account Representatives on above data.
• Maintain files with insurance authorizations and referral information.
• Attend staff meetings and participate in professional development activities.

Skills

Customer service

Medical terminology

Eligibility & prior auth

Communication

Multiline phone handling

Education

High School Diploma or GED

Tools

Computer skills

Job description

New Mexico Orthopaedic Associates P C in Albuquerque, NM is seeking a Benefits Verification and Prior Authorization Specialist to support providers with timely benefits checks and approvals. The role requires accuracy in demographic data, credentialing review, and coordination with clinic teams.

Responsibilities include obtaining referrals, managing authorizations for procedures and DME, and maintaining compliant patient records.