Prior Authorization Specialist

The VIOS Clinic; Valentine (NE); On-site; USD 50,000 - 70,000; Full time

Job summary

The VIOS Clinic in Valentine, Nebraska, is seeking an Authorization Specialist to manage insurance approvals for medical services. You will verify coverage, prepare authorization requests, and interpret medical necessity guidelines to support timely patient care.

Collaborating with providers, nurses, and payers, you will document activities, communicate decisions to staff and patients, and help resolve denials by gathering information and coordinating next steps.

Qualifications

• Detail-oriented with strong accuracy and documentation skills.
• Ability to interpret payer requirements and medical necessity criteria.
• Effective communication and coordination with clinical teams and payers.
• Strong organizational skills to track multiple authorization requests.
• Problem-solving skills to address denials and prevent interruptions in care.

Responsibilities

• Verify insurance coverage for requested services and procedures.
• Submit, monitor, and manage authorization requests to ensure approvals are received.
• Interpret medical necessity guidelines and apply them to authorization documentation.
• Collaborate with providers, nurses, and payers to reduce delays in care.
• Document all authorization activities and maintain accurate records.
• Communicate authorization decisions to patients and clinical staff.
• Support resolution of denials by gathering required information and coordinating next steps.

Skills

Attention to detail

Medical necessity interpretation

Communication with providers

Organization

Problem solving

Job description

responsible for obtaining timely approvals for medical services and procedures.

Key Duties

• Verify insurance coverage for requested services and procedures.
• Submit, monitor, and manage authorization requests to ensure approvals are received.
• Interpret medical necessity guidelines and apply them to authorization documentation.
• Collaborate with providers, nurses, and payers to reduce delays in care.
• Document all authorization activities and maintain accurate records.
• Communicate authorization decisions to patients and clinical staff.
• Support resolution of denials by gathering required information and coordinating next steps.

Qualifications & Skills

• Detail-oriented with strong accuracy and documentation skills.
• Ability to interpret payer requirements and medical necessity criteria.
• Effective communication and coordination with clinical teams and payers.
• Strong organizational skills to track multiple authorization requests.
• Problem-solving skills to address denials and prevent interruptions in care.