Prior Authorization Specialist

Provident Behavioral Health; Naples (FL); On-site; USD 42,000 - 58,000; Full time

Job summary

Provident Behavioral Health in Naples, FL seeks a dedicated Authorization Specialist to coordinate insurance authorizations and precertifications for medical services, procedures, diagnostics, and medications. You will review coverage requirements, submit requests with clinical documentation, and track approvals to completion.

Strong communication with clinical teams, meticulous documentation, and proactive follow-up are essential to ensure accurate reimbursement and denial resolution.

Qualifications

• Strong knowledge of authorization/precertification processes and insurance coverage requirements.
• Attention to detail in documentation and request submission.
• Effective communication and ability to coordinate with clinical teams.
• Ability to track approvals, handle exceptions, and support reimbursement accuracy.

Responsibilities

• Verify payer coverage requirements for requested services and medications
• Prepare and submit authorization/precertification requests using required clinical documentation
• Monitor approval status and manage follow-ups for pending cases
• Communicate authorization outcomes and status updates to care teams
• Assist with resolving denials and supporting accurate, timely reimbursement

Job description

Role Summary

Coordinate insurance authorizations and precertifications for medical services, procedures, diagnostic testing, and medications. Review coverage requirements, submit authorization requests with appropriate clinical documentation, and track pending approvals through completion.

Coordinate insurance authorizations and precertifications for medical services, procedures, diagnostic testing, and medications. Review coverage requirements, submit authorization requests with appropriate clinical documentation, and track pending approvals through completion.

Key Duties

• Verify payer coverage requirements for requested services and medications
• Prepare and submit authorization/precertification requests using required clinical documentation
• Monitor approval status and manage follow-ups for pending cases
• Communicate authorization outcomes and status updates to care teams
• Assist with resolving denials and supporting accurate, timely reimbursement

Qualifications & Skills

• Strong knowledge of authorization/precertification processes and insurance coverage requirements
• Attention to detail in documentation and request submission
• Effective communication and ability to coordinate with clinical teams
• Ability to track approvals, handle exceptions, and support reimbursement accuracy