Prior Authorization Specialist

LifeBridge Health; Baltimore (MD); On-site; USD 49,000 - 72,000; Full time

Job summary

LifeBridge Health is seeking a Prior Authorization Specialist to facilitate the authorization process between patients, healthcare providers, and insurance companies. This role is crucial in ensuring timely patient access to necessary treatments while remaining compliant with payer rules. Candidates should possess strong communication skills, organizational abilities, and relevant healthcare administration education.

Qualifications

• 1 year of experience required; 3+ years preferred.
• Certified Medical Administrative Assistant and/or Certified Professional Coder preferred.
• Experience in healthcare administration or medical office management preferred.

Responsibilities

• Act as a liaison between patients, healthcare providers, and insurance companies.
• Contact insurance companies for prior authorization requests.
• Review medical records to assess the need for treatments.

Skills

Communication

Attention to Detail

Problem Solving

Education

Post-secondary education in healthcare administration or related field

Tools

Medical coding software

Job description

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JOB SUMMARY:

The Prior Authorization Specialist will act as a liaison between the patients, healthcare providers, and insurance companies, ensuring treatments are authorized and covered. The role will support both the family medicine and specialty practice. The Prior Authorization Specialist supports timely patient access to medically necessary care by coordinating and obtaining insurance authorizations for medications, diagnostic testing, procedures, and durable medical equipment (DME). This role is essential in reducing care delays and ensuring compliance with payer requirements. The specialist serves as a liaison between providers, patients, and insurance companies to ensure accurate and efficient processing of prior authorizations in a busy outpatient setting.

• Contacting insurance companies to initiate prior authorization request.
• Reviewing patient medical records to assess the need for requested treatments or medications.
• Providing supporting documentation to justify the medical necessity of a treatment.
• Following up with insurance companies on the status of prior authorization requests.
• Appealing denied prior authorization requests when clinically appropriate.
• Communicating with patients and providers regarding prior authorization status and potential delays.
• Identifying opportunities to streamline the prior authorization process within the practice.
  
  

Summary

JOB SUMMARY:

The Prior Authorization Specialist will act as a liaison between the patients, healthcare providers, and insurance companies, ensuring treatments are authorized and covered. The role will support both the family medicine and specialty practice. The Prior Authorization Specialist supports timely patient access to medically necessary care by coordinating and obtaining insurance authorizations for medications, diagnostic testing, procedures, and durable medical equipment (DME). This role is essential in reducing care delays and ensuring compliance with payer requirements. The specialist serves as a liaison between providers, patients, and insurance companies to ensure accurate and efficient processing of prior authorizations in a busy outpatient setting.

• Contacting insurance companies to initiate prior authorization request.
• Reviewing patient medical records to assess the need for requested treatments or medications.
• Providing supporting documentation to justify the medical necessity of a treatment.
• Following up with insurance companies on the status of prior authorization requests.
• Appealing denied prior authorization requests when clinically appropriate.
• Communicating with patients and providers regarding prior authorization status and potential delays.
• Identifying opportunities to streamline the prior authorization process within the practice.
  
  

Requirements

• 1 year of experience required; 3+ years of experience preferred.
• Certified Medical Administrative Assistant and/or Certified Professional Coder preferred.
• Post-secondary education in healthcare administration, medical office management, or a related field preferred with disciplines including health information management, medical billing/coding, healthcare administration, or related areas.
  
  

Additional Information

As one of the largest health care providers in Maryland, with 13,000 team members, We strive to CARE BRAVELY for over 1 million patients annually. LifeBridge Health includes Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital and Grace Medical Center, as well as our Community Physician Enterprise, Center for Hope, Practice Dynamics, and business partners: LifeBridge Health & Fitness, ExpressCare and HomeCare of Maryland.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Hospitals and Health Care

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