Prior Authorization Specialist

Shoreline Healthcare Technologies; United States; Hybrid; USD 42,000 - 64,000; Full time

Job summary

Shoreline Healthcare Technologies is seeking an experienced insurance authorization specialist to obtain pre-service treatment authorizations and verify patient insurance eligibility across Orthopedics, Cardiology, Oncology, and Pain Management. The role involves verifying benefits, copay requirements, and documenting all communications efficiently.

The candidate will interact with insurance carriers, review medical history for authorization needs, and follow HIPAA-compliant procedures.

Qualifications

• 1+ years experience in medical prior authorization or eligibility verification.
• Familiarity with CPT surgical codes, ICD-10 medical necessity criteria, and payer portals.
• Strong organizational skills and ability to manage urgent pre-procedure requests.

Responsibilities

• Obtain pre-service treatment authorizations and verify patient insurance eligibility, benefits coverage, and copay requirements across major medical specialties.
• Contact insurance carriers to verify patient insurance eligibility, benefits and requirements.
• Review patient medical history and provide pertinent information for authorization requirements.
• Input patient information and update system as needed.
• Monitor schedule and work with hospital to obtain authorizations for add-on procedures.
• Demonstrate knowledge of medical terminology including HIPAA regulations.
• Clearly document all communications in the patient chart.
• Communicate insurance trends or changes to the team.
• Adhere to all policies and perform other duties as assigned.

Skills

Prior authorization

Eligibility verification

CPT/ICD-10 familiarity

Organizational skills

Job description

Responsible for obtaining pre-service treatment authorizations, verifying patient insurance eligibility, benefits coverage, and copay requirements across major medical specialties (Orthopedics, Cardiology, Oncology, Pain Management).

Key Responsibilities:

• Contact insurance carriers to verify patient s insurance eligibility, benefits and requirements.
• Review patient s medical history and provide pertinent information for authorization requirements.
• Requires, follow up and secure prior authorizations prior to services.
• Input patient information and update system if needed.
• Monitor schedule and work with hospital to obtain authorizations for add-on procedures.
• Demonstrate and apply knowledge of medical terminology including HIPPA regulations.

• Clearly document all communications and contacts in patient s chart.
• Communicate with any trends or insurance changes among team.
• Attention to detail.
• Copying and faxing.
• Practice and adhere to the Code of Conduct philosophy Mission and Value Statement.
• Must read, understand, and adhere to all Physician Services policies and procedures.
• Other duties as assigned.

Qualifications & Requirements:

• 1+ years experience in medical prior authorization or eligibility verification.
• Familiarity with CPT surgical codes, ICD-10 medical necessity criteria, and payer portals.

• Strong organizational skills and ability to manage urgent pre-procedure requests.

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.