Prior Authorization Pro: Healthcare Payer Liaison

Med Center Health; Bowling Green (KY); Presencial; USD 38.000 - 46.000; Jornada completa

Descripción de la vacante

Med Center Health in the United States seeks an Authorization Specialist to obtain prior authorizations, precertifications, and other payer approvals for scheduled services. You will liaise with providers, staff, patients, and payers to gather information, submit requests, and follow up to minimize delays in care.

This role requires strong communication, organization, and knowledge of payer processes. You will document activity, escalate issues, and support timely financial clearance across

Formación

• Experience in healthcare, insurance verification, prior authorization, patient access, revenue cycle, or a related field preferred.
• Strong verbal and written communication skills.
• Strong organizational skills and attention to detail.
• Ability to manage multiple priorities and meet established deadlines.

Responsabilidades

• Reviews scheduled services and procedures to determine authorization, precertification, or other payer approval requirements.
• Obtains prior authorizations, precertifications, and other payer-required approvals for scheduled services and procedures.
• Verifies payer requirements, coverage guidelines, clinical documentation needs, and submission processes.
• Communicates with insurance carriers, provider offices, clinical departments, scheduling teams, and patients as needed to obtain information required for authorization requests.
• Submits authorization requests with accurate patient, provider, service, diagnosis, procedure, and supporting clinical information.
• Monitors authorization work queues and follows up on pending requests to support timely financial clearance.
• Tracks authorization status, payer determinations, approval numbers, effective dates, and related information in designated systems.
• Communicates authorization approvals, delays, denials, missing information, or other issues to appropriate stakeholders in a timely manner.
• Escalates complex authorization issues, payer delays, urgent requests, or potential barriers to the appropriate supervisor or department contact.
• Assists with authorization-related denials, payer inquiries, and requests for additional information.
• Maintains current knowledge of payer authorization requirements, medical necessity guidelines, coverage policies, and workflow changes.
• Ensures authorization processes are completed in accordance with payer requirements, regulatory standards, and organizational policies.
• Supports denial prevention efforts by ensuring authorization accuracy, timely follow-up, and complete documentation.
• Participates in process improvement activities to enhance authorization efficiency, accuracy, and service quality.

Conocimientos

Verbal and written communication

Organization & attention to detail

Multitasking & prioritization

Computer proficiency

Educación

High School Diploma or GED preferred

Herramientas

Epic or similar EHR systems

Descripción del empleo

Med Center Health in the United States seeks an Authorization Specialist to obtain prior authorizations, precertifications, and other payer approvals for scheduled services. You will liaise with providers, staff, patients, and payers to gather information, submit requests, and follow up to minimize delays in care.

This role requires strong communication, organization, and knowledge of payer processes. You will document activity, escalate issues, and support timely financial clearance across