Prior Authorization & Denials Specialist

Brown University Health; South Kingstown (RI); On-site; USD 26,000 - 43,000; Full time

Job summary

Brown University Health is seeking a detail-oriented professional to manage the integrity of the department's insurance prior authorization process at Brown Dermatology in South Kingstown, RI. This role coordinates visits, procedures, drug orders, infusions, radiology orders, and referrals, ensuring timely financial clearance from insurers.

The ideal candidate has strong medical terminology knowledge, excellent organizational skills, and experience with payer communications to resolve denials

Qualifications

• High School diploma or equivalency required.
• Knowledge of business systems and basic computer skills.
• Strong medical terminology knowledge.
• Excellent organization for high volume prior authorizations.
• Effective customer relations and communications with patients and staff.
• Analytical skills to evaluate workflow and reports.

Responsibilities

• Collaborate with physicians to schedule peer-to-peer discussions for prior authorizations.
• Ensure orders are complete, legible, and scanned in the EMR; obtain necessary documentation.
• Coordinate information for managing insurance denials and referrals.
• Participate in team meetings to identify process improvements.
• Review referrals and pre-authorizations from insurers for accuracy and notification of registration.
• Train staff on changes to hospital or third-party procedures.

Skills

Organizational skills

Medical terminology

Customer service

Analytical skills

Communication

Education

High School diploma

Tools

Electronic Medical Record (EMR)

Computer skills

Job description

Brown University Health is seeking a detail-oriented professional to manage the integrity of the department's insurance prior authorization process at Brown Dermatology in South Kingstown, RI. This role coordinates visits, procedures, drug orders, infusions, radiology orders, and referrals, ensuring timely financial clearance from insurers.

The ideal candidate has strong medical terminology knowledge, excellent organizational skills, and experience with payer communications to resolve denials