Prior Authorization & Insurance Verification Specialist

Peachtree Orthopedics; Atlanta (GA); On-site; USD 50,000 - 65,000; Full time

Job summary

Peachtree Orthopedics seeks a Pre-Certification Coordinator to support authorization and reimbursement processes within the Revenue Cycle department. You will obtain prior authorizations, verify benefits, and coordinate payer requirements to ensure timely patient care.

You will collaborate with clinical teams and other departments to maintain accurate documentation, meet turnaround times, and resolve authorization-related issues while upholding regulatory and internal policies.

Qualifications

• Healthcare, medical office, insurance verification, authorization, or revenue cycle experience required.
• Knowledge of ICD-10, CPT, HCPCS coding and insurance authorization processes preferred.
• Experience with Athena and EMR systems preferred.
• Strong organizational and communication skills.

Responsibilities

• Obtain and verify prior authorizations, precertifications, and treatment approvals for medical services.
• Verify insurance eligibility, benefits, provider participation, and COB/coverage requirements before service delivery.
• Review payer requirements and analyze information to determine authorization and reimbursement needs.
• Ensure all authorization requests are submitted accurately within department turnaround times.
• Communicate authorization status updates to clinical teams and departments in a timely manner.
• Maintain documentation of authorization activities and payer communications in the practice management system.
• Monitor pending requests and follow up with insurance carriers to minimize delays.
• Research and resolve authorization-related issues and payer inquiries.
• Collaborate with Scheduling, Clinical, Billing, Front Desk, and Revenue Cycle teams to improve workflows.
• Ensure HIPAA, CMS guidelines, payer regulations, and policies are followed.
• Participate in meetings, audits, training, and process improvement initiatives.

Skills

Organizational skills

Analytical skills

Communication skills

Problem-solving

Education

High school diploma or equivalent

Associate’s degree preferred

Tools

Athena

Electronic Medical Records

Microsoft Word

Excel

PowerPoint

Practice management systems

Job description

Peachtree Orthopedics seeks a Pre-Certification Coordinator to support authorization and reimbursement processes within the Revenue Cycle department. You will obtain prior authorizations, verify benefits, and coordinate payer requirements to ensure timely patient care.

You will collaborate with clinical teams and other departments to maintain accurate documentation, meet turnaround times, and resolve authorization-related issues while upholding regulatory and internal policies.