Prior Authorization Specialist — Care & Reimbursement

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

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.