Prior Authorization Specialist

GeBBS Healthcare Solutions, Inc.; United States; Remote; USD 30,000 - 41,000; Full time

Job summary

GeBBS Healthcare Solutions, Inc. is hiring an Authorization Representative to manage prior authorizations across CT, MRI, surgery, and other services within the U.S. healthcare payers.

You will verify eligibility, track requests, manage renewals, and address denials and appeals while collaborating with billing, clinical and operations teams to maintain timely authorizations and optimize reimbursement. This remote role requires strong attention to detail, knowledge of payer portals (Availity,

Qualifications

• Experience in healthcare Revenue Cycle Management.
• Experience with prior authorization, eligibility and benefits verification.
• Experience working with commercial and managed care payers.
• Experience using payer portals such as Availity and NaviNet.
• Ability to track and resolve authorizations and denials.

Responsibilities

• Initiate, submit, and track prior authorization requests across commercial and managed care payers.
• Verify patient eligibility and benefits prior to submission.
• Monitor pending authorizations and follow up to resolution.
• Manage concurrent reviews, renewals, and expiration date tracking.
• Review denials and coordinate appeals with clinical and operational teams.
• Coordinate with billing and other teams to resolve reimbursement barriers.
• Maintain accurate authorization records and reporting.
• Ensure compliance with HIPAA and privacy requirements.

Skills

Prior Authorization

Eligibility verification

Payer follow-up

Revenue cycle

HIPAA compliance

CPT codes

Tools

Availity

NaviNet

Job description

GeBBS Healthcare Solutions is a leading provider of Revenue Cycle Management (RCM) and Risk Adjustment services, helping healthcare organizations optimize operations, improve financial performance, maintain compliance, and enhance the patient experience. Recognized as a KLAS® Top Performer, GeBBS combines innovative technology, industry expertise, and a commitment to excellence to deliver measurable results for clients across the healthcare industry. We are dedicated to being a trusted healthcare partner by upholding the highest standards of quality, information security, and compliance.

At GeBBS, we foster a collaborative and growth-oriented culture where employees are empowered to develop their skills, advance their careers, and make a meaningful impact in transforming healthcare.

Responsibilities

The Authorization Representative will need to cover authorizations for all services (CT, MRI, echo, surgery, minor procedures, heart monitor, PFTs, sleep studies, IP, Observations, Swing Bed, ED, VA), excluding STAT requests.
Initial request and follow up required along with reporting of authorization status.

Prior Authorization and Eligibility

• Initiate, submit, and track prior authorization requests across commercial and managed care payers.
• Verify patient eligibility and benefits prior to authorization submission and confirm coverage, plan requirements, authorization thresholds, deductibles, copays, and other applicable benefit information.
• Ensure authorization requests contain complete and accurate demographic, clinical, and supporting documentation.
• Monitor pending authorization requests through payer portals and direct payer communication and proactively follow up through resolution.
• Document authorization numbers, approved services, CPT codes, effective dates, expiration dates, session or visit limits, and other payer requirements.

Concurrent Reviews and Authorization Management

• Manage concurrent review, continued stay, and authorization renewal requirements for ongoing services.
• Track authorization limits and expiration dates and initiate renewals before existing authorizations are exhausted.
• Maintain accurate authorization records and communicate pending or expiring authorizations to appropriate operational and clinical teams.
• Help prevent gaps in authorization that could result in delayed services or lost reimbursement.

Denials and Appeals

• Review authorization-related denials and determine whether the cause is clinical, administrative, eligibility-related, or procedural.
• Coordinate appropriate corrective action and appeal activity within payer deadlines.
• Prepare clear and accurate appeal documentation and coordinate with clinical and operational teams to obtain supporting information when required.
• Track appeals through resolution and maintain complete documentation of outcomes.
• Identify recurring denial trends and elevate systemic payer or process issues.

Payer and Revenue Cycle Coordination

• Serve as a resource for payer authorization requirements, policies, portals, and workflows.
• Maintain current knowledge of payer requirements and communicate material changes to appropriate teams.
• Coordinate with billing, intake, clinical, credentialing, and contracting teams to resolve authorization-related reimbursement barriers.
• Support single-case agreements, out-of-network authorization requests, and other payer authorization functions as needed.
• Assist with payer audits and utilization management reviews by providing complete authorization records and supporting documentation.

Documentation and Reporting

• Maintain accurate and timely authorization activity within applicable EHR, practice management, and tracking systems.
• Maintain payer authorization matrices and workflow documentation, including submission requirements, turnaround times, authorization limits, and renewal requirements.
• Track authorization performance, including approval rates, denial rates, appeal outcomes, turnaround times, and outstanding requests.
• Identify trends and recommend workflow improvements that strengthen revenue integrity and reduce preventable denials.
• Maintain compliance with HIPAA and all applicable privacy and confidentiality requirements.

Qualifications

• Previous experience in healthcare Revenue Cycle Management, with direct responsibility for prior authorization, eligibility and benefit verification, payer follow-up, or related revenue cycle functions.
• Strong understanding of prior authorization requirements, payer timelines, submission processes, and authorization tracking.
• Strong understanding of the differences between eligibility, benefits, authorization, and medical necessity requirements.
• Experience working with commercial and managed care payers.
• Experience using payer portals such as Availity, NaviNet, and payer-specific platforms.
• Working knowledge of CPT codes and their relationship to payer authorization requirements.
• Experience managing denials and authorization appeals.
• Experience with EHR, practice management, or other healthcare revenue cycle systems.

Requirements

• Excellent attention to detail and analytical skills.
• Strong organizational skills with the ability to manage multiple authorization queues and deadlines simultaneously.
• Strong written and verbal communication skills and the ability to work effectively with payer representatives and internal operational teams.
• Working knowledge of HIPAA and healthcare privacy requirements.
• US based candidates eligible for employment without sponsorship.

The pay range for this role is:

26 - 26 USD per hour (Remote (United States))