Prior Authorization & Insurance Verification Specialist

AdventHealth; Parker (CO); On-site; USD 29,000 - 47,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

Paid Time Off (PTO)

401(k) plan

Parental leave

Career development

Well-being resources

Job summary

AdventHealth Parker, CO seeks a Billing and Authorization Specialist to monitor referrals, verify prior authorization, and submit documentation in Epic EMR. You will coordinate with providers, nursing, pharmacy, and front desk, estimate patient costs, and support billing questions while ensuring payer requirements and regulatory compliance.

This full-time day-shift role offers benefits from day one and opportunities for career development within AdventHealth.

Qualifications

• Medical terminology required.
• Insurance eligibility and verification required.
• Minimum of 1 year health care experience required.
• Knowledge of ICD 10 and CPT coding required.
• Good customer service skills required.
• Computer skills and willingness to use technology required.
• Epic knowledge preferred.
• Registration and billing knowledge preferred.

Responsibilities

• Monitors work queues for authorized and expiring medication-based referrals.
• Verifies prior authorization requirements based on patient insurance.
• Obtains clinical and treatment information from patient charts.
• Submits clinical documentation with prior authorization requests and tracks status.
• Schedules peer-to-peer or appeal as needed.
• Documents authorization information in Epic EMR.
• Communicates insurance coverage, benefits, and authorization status with providers and teams.
• Provides patient cost estimates based on treatment protocol and benefits.
• Keeps schedule informed about self-pay patients and estimates.
• Coordinates patient care with third-party copay and free drug vendors.
• Addresses patient questions with Revenue Management and Billing teams.
• Maintains knowledge of chemotherapy authorization requirements for payers and regulations.

Skills

Medical terminology

Insurance eligibility and verification

Healthcare experience

ICD-10 and CPT coding

Customer service

Computer skills

Education

High School Grad or Equiv

Associate

Bachelor's

Tools

Epic

Job description

AdventHealth Parker, CO seeks a Billing and Authorization Specialist to monitor referrals, verify prior authorization, and submit documentation in Epic EMR. You will coordinate with providers, nursing, pharmacy, and front desk, estimate patient costs, and support billing questions while ensuring payer requirements and regulatory compliance.

This full-time day-shift role offers benefits from day one and opportunities for career development within AdventHealth.