Prior Authorization & Benefits Specialist

Alliance Family Health Center Inc; Liberty Township (OH); On-site; USD 42,000 - 64,000; Full time

Job summary

Alliance Family Health Center, Inc. is seeking a dedicated Prior Authorization Specialist to manage patient authorizations and benefit verifications, coordinating with payers and providers to ensure care is delivered as directed by providers.

The role emphasizes processing authorizations, communicating with patients and clinicians, and maintaining smooth office operations within facility guidelines.

Qualifications

• Medical office experience preferred.
• Experience with Scheduling and Authorizations is required.
• Knowledge of medical terminology.
• Proficient with MS Word and Excel.

Responsibilities

• Inputs, processes, reviews, and logs authorization requests and auto-authorizations per guidelines and defined time/accuracy standards.
• Requests authorization extensions or peer-to-peer reviews when necessary to ensure continuity of care.
• Process all STAT authorizations with immediate priority to prevent delays in urgent treatment.
• Notify patients and providers of authorization status, including approvals, denials, or pending requests.
• Perform detailed Benefits Investigation, including verifying coverage for procedures, medications, and DME.
• Secure approvals for outpatient diagnostic imaging (MRI, CT, PET).
• Coordinate authorizations for referrals and attach necessary clinical documentation.
• Provide administrative support to maintain office flow.
• Maintain effective communication with supervisors, providers, and clinical staff regarding delays.
• Attend department meetings and training sessions as directed.
• Other duties as assigned.

Skills

Scheduling

Authorizations

Medical terminology

Customer service

Computer literacy

Education

High school diploma or equivalent

Tools

Microsoft Office

eClinicalWorks

Availity

RadMD

MS Word

Excel

Job description

Alliance Family Health Center, Inc. is seeking a dedicated Prior Authorization Specialist to manage patient authorizations and benefit verifications, coordinating with payers and providers to ensure care is delivered as directed by providers.

The role emphasizes processing authorizations, communicating with patients and clinicians, and maintaining smooth office operations within facility guidelines.