Prior Authorization Specialist

Itrust Wellness Group; Greenville (SC); Hybrid; USD 52,000 - 68,000; Full time

Job summary

iTrust Wellness seeks a detail-oriented Prior Authorization Specialist for our Greenville or Anderson offices. You will manage authorization requests, coordinate with providers and insurers, and monitor approvals to expedite patient access to care.

The role requires experience with EHR systems, CPT/ ICD coding, and strong HIPAA compliance. Excellent communication with patients and staff is essential.

Qualifications

• High School Diploma or equivalent.
• Prior Authorization experience in medical settings.
• Experience using EHR systems.
• Knowledge of health insurance policies and verification procedures.
• Familiarity with CPT/ICD coding and medical terminology.
• Proficiency with Microsoft Office.

Responsibilities

• Process medication prior authorization requests with insurance companies to ensure timely patient care.

Skills

Prior Authorization

Insurance Knowledge

Medical Terminology

CPT Coding

ICD Coding

EHR Management

Microsoft Office

Customer Service

HIPAA Compliance

Medical Records

Medical Billing

Education

High School Diploma

Tools

EHR Systems

Job description

iTrust Wellnessis seeking a detail-orientedPrior Authorization Specialistto join our outpatient mental health practice in our Greenville or Anderson office. This position is ideal for someone with strong organizational and communication skills, experience navigating insurance requirements and authorization processes, and a passion for helping ensure patients receive timely access to the care they need in a collaborative, team-oriented environment.

Primary Responsibilities:

Prior Authorization Management:

• Processing medication prior authorization requests from insurance companies to ensure timely patient care.
• Coordinate with providers, pharmacies, pharmaceutical representatives, and insurance companies to obtain required information and resolve any issues related to prior authorizations.
• Monitor the status of prior authorization requests, follow up on pending approvals, and elevate urgent cases as needed to expedite the process.
• Maintain accurate and detailed records of prior authorization requests, approvals, denials, and appeals.
• Maintain accurate and detailed records of insurance company expectations, formularies, etc.
• Stay updated on insurance company guidelines, formularies, and prior authorization requirements to ensure compliance and maximize approval rates.

Requirements and Experience

• High School Diploma (or equivalent)
• Prior Authorization experience in a medical office setting or healthcare environment is highly preferred.
• Experience using EHR systems.
• Strong knowledge of health insurance policies, managed care processes, and insurance verification procedures.
• Proficiency in medical terminology, CPT coding, ICD coding (ICD-9 and ICD-10), and electronic health records (EHR/EHR management).
• Familiarity with Microsoft Office applications for documentation and communication purposes.
• Excellent customer service skills with the ability to communicate effectively with patients, providers, and insurance representatives.
• Understanding of clinical confidentiality policies such as HIPAA is essential for maintaining patient privacy.
• Previous experience handling medical records, medical billing, or insurance prior authorization processes.