Prior Authorization Specialist

Functional Medicine of Idaho; Meridian (ID); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

401(k) with Employer Match

Dental Insurance

Health Insurance

Life Insurance

Vision Insurance

Paid Time Off

Employee Discounts on Wellness

Job summary

Functional Medicine of Idaho in Idaho is seeking a dedicated Prior Authorization Specialist to coordinate, obtain, and document prior authorizations for medical services and medications. You will work to ensure timely patient care and accurate reimbursement through strong communication and meticulous record-keeping.

Responsibilities include verifying coverage, submitting requests via multiple channels, tracking status, and collaborating with billing and clinical teams to resolve denials.

Qualifications

• The Prior Authorization Specialist coordinates, obtains and documents prior authorizations for medical services, procedures and medications.
• Requires strong communication skills, attention to detail, and the ability to navigate payer requirements efficiently.

Responsibilities

• Verify patient insurance coverage and eligibility.
• Review provider orders to determine if prior authorization is required.
• Submit prior authorization requests to insurance companies via phone, fax, or payer portals.
• Track, follow up, and document the status of all pending authorizations.
• Communicate authorization outcomes to providers, clinical staff, and patients.
• Collaborate with billing and clinical teams to resolve denials or delays.
• Maintain accurate records of all authorization activities in the practice.
• Ensure compliance with payer policies and HIPAA regulations.
• Assist with appeals when authorizations are denied.
• Perform other related duties within the Billing Department as assigned.

Skills

Prior Authorization

Insurance Verification

Communication

Attention to Detail

Job description

Description

At Functional Medicine of Idaho (FMI), we are committed to helping people thrive by providing personalized, integrative healthcare that addresses the root causes of health concerns. Our mission is to empower individuals at every stage of life, guiding them toward optimal well-being. We focus on delivering comprehensive, patient-centered care rooted in the latest research and compassionate service. At FMI, we value collaboration, innovation, and empathy, and are dedicated to offering the best functional and integrative medicine in the communities we serve. Join our team and be part of transforming healthcare while making a meaningful impact.

• 401(k) with Employer Match
• Employee Assistance Program
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off
• Employee Discounts on Wellness services, Supplements, & more!

Description

At Functional Medicine of Idaho (FMI), we are committed to helping people thrive by providing personalized, integrative healthcare that addresses the root causes of health concerns. Our mission is to empower individuals at every stage of life, guiding them toward optimal well-being. We focus on delivering comprehensive, patient-centered care rooted in the latest research and compassionate service. At FMI, we value collaboration, innovation, and empathy, and are dedicated to offering the best functional and integrative medicine in the communities we serve. Join our team and be part of transforming healthcare while making a meaningful impact.

Benefits

• 401(k) with Employer Match
• Dental Insurance
• Employee Assistance Program
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off
• Employee Discounts on Wellness services, Supplements, & more!

Job Summary

The Prior Authorization Specialist is responsible for coordinating, obtaining, and documenting prior authorizations for medical services, procedures, and medications to ensure timely patient care and accurate reimbursement. This role requires strong communication skills, attention to detail, and the ability to navigate payer requirements efficiently.

Key Responsibilities

• Verify patient insurance coverage and eligibility.
• Review provider orders to determine if prior authorization is required.
• Submit prior authorization requests to insurance companies via phone, fax, or payer portals.
• Track, follow up, and document the status of all pending authorizations.
• Communicate authorization outcomes to providers, clinical staff, and patients.
• Collaborate with billing and clinical teams to resolve denials or delays.
• Maintain accurate records of all authorization activities in the practice
• Ensure compliance with payer policies and HIPAA regulations.
• Assist with appeals when authorizations are denied.
• Perform other related duties within the Billing Department as assigned, including but not limited to claim follow-up, payment posting, or insurance verification, to support overall departmental operations.

Work Environment & Schedule

• Full-time position

Equal Opportunity Employer

Functional Medicine of Idaho is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, age, sex, marital status, national origin, ancestry, disability, handicap or veteran status.

Requirements

FMIHIGHP