Prior Authorization Expert: Accelerate Care & Revenue

Graves Gilbert Clinic; Bowling Green (KY); On-site; USD 40,000 - 52,000; Full time

Job summary

Graves Gilbert Clinic seeks a detail-oriented Prior Authorization Specialist in Bowling Green, KY to verify patient eligibility and insurance benefits for clinic-administered medications. You will obtain and monitor authorizations via payer portals, fax, and telephone, ensuring timely processing and accurate documentation.

Working with clinicians and managers, you’ll gather medical notes, confirm medical necessity, load plan IDs, and determine patient financial responsibility to support precise

Qualifications

• Prior experience in authorization processing and benefit investigation.
• Experience with specialty medication authorizations preferred.
• Strong attention to detail and accuracy.
• Excellent time management and organizational skills.
• Proficiency in Microsoft Excel and related software applications.
• Strong interpersonal and communication skills.
• Ability to interpret insurance benefits, authorization guidelines, and medical terminology.
• Ability to work collaboratively in a fast-paced, team-oriented environment.

Responsibilities

• Initiate, monitor, and secure prior authorizations from third-party payers.
• Maintain electronic documentation for all prior authorization activities.
• Track pending authorizations and follow up within defined timeframes (7–10 days or payer-specific requirements) to support timely claims submission.
• Obtain authorization renewals and verify active provider orders and medical necessity documentation.
• Collaborate with clinicians, practice managers, and team members to obtain documentation.
• Verify authorization quantities and effective dates; ensure correct loading in internal systems.
• Review and confirm patient eligibility, insurance benefits, and plan requirements.
• Interpret payer guidelines and ensure approvals are documented.
• Input Payer Plan ID numbers into organizational systems for correct billing.
• Determine patient financial responsibility, including COB and other coverage considerations.
• Organize workload and manage deadlines to prevent delays or loss of revenue.
• Maintain professional communication with all payers, clinicians, and team members.
• Perform additional duties as assigned.

Skills

Attention to detail

Time management

Organizational skills

Interpersonal communication

Team collaboration

Communication skills

Tools

Microsoft Excel

Job description

Graves Gilbert Clinic seeks a detail-oriented Prior Authorization Specialist in Bowling Green, KY to verify patient eligibility and insurance benefits for clinic-administered medications. You will obtain and monitor authorizations via payer portals, fax, and telephone, ensuring timely processing and accurate documentation.

Working with clinicians and managers, you’ll gather medical notes, confirm medical necessity, load plan IDs, and determine patient financial responsibility to support precise