Prior Authorization Pro - Healthcare Billing

Socket.dev; Las Vegas (NV); On-site; USD 40,000 - 52,000; Full time

Job summary

New Horizon Billing Solutions (NHBS) is seeking a detail-oriented Prior Authorization Specialist to verify insurance eligibility, manage IVRs, and process prior authorizations. You will handle payer portal workflows, document outcomes, and coordinate with client offices while ensuring HIPAA compliance.

The role emphasizes accurate data entry, timely processing of requests, and escalation of issues to avoid claim denials and support a clean revenue cycle in an in-office Las Vegas environment.

Qualifications

• High school diploma or GED required.
• 2+ years in prior authorization, insurance verification, or medical billing/front-office operations in a healthcare setting.
• Familiarity with Medicare Part A/Part B eligibility rules, MSP, and commercial payer structures.

Responsibilities

• Verify Medicare eligibility and benefits through MAC portals and commercial payer portals.
• Prepare, submit, and track prior authorization requests with clinical documentation.
• Maintain audit-ready documentation and escalate workflow blockers as needed.

Skills

Attention to detail

Prioritization

Communication

HIPAA compliance

Education

High school diploma or GED

Tools

Payer portals

EHR systems

Microsoft Office

Job description

New Horizon Billing Solutions (NHBS) is seeking a detail-oriented Prior Authorization Specialist to verify insurance eligibility, manage IVRs, and process prior authorizations. You will handle payer portal workflows, document outcomes, and coordinate with client offices while ensuring HIPAA compliance.

The role emphasizes accurate data entry, timely processing of requests, and escalation of issues to avoid claim denials and support a clean revenue cycle in an in-office Las Vegas environment.