Prior Authorization Specialist: Elevate Patient Access

Socket.dev; Hancock Township (MI); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Comprehensive Benefits

PTO & protections

Career Growth

Well-being programs

Professional Development

Job summary

UP Health System – Portage in Michigan is seeking a dedicated Prior Authorization Specialist to join our patient access team. You will contact insurance carriers to obtain benefit coverage, verify eligibility, obtain pre-certifications, and coordinate pre-authorization for identified patients in collaboration with physicians and staff.

This role requires strong critical thinking, decisive judgment, and the ability to work with minimal supervision.

Qualifications

• Requires critical thinking skills and decisive judgment to work with minimal supervision.
• Knowledge of Medicare/Medicaid and third-party payer requirements is a plus.
• Ability to coordinate with physicians, staff and payers for pre-authorizations.

Responsibilities

• Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization and pre-certifications.
• Follows up with physician offices, financial counselors and payers to complete pre-certification.
• Coordinates with supervisors and clinical staff to resolve issues and appeal denials.
• Ensures information is complete, accurate and in line with payer requirements.
• Educates patients and staff on referral and pre-authorization requirements.

Skills

Critical thinking

Decisive judgment

Education

High School Diploma or Equivalent

Job description

UP Health System – Portage in Michigan is seeking a dedicated Prior Authorization Specialist to join our patient access team. You will contact insurance carriers to obtain benefit coverage, verify eligibility, obtain pre-certifications, and coordinate pre-authorization for identified patients in collaboration with physicians and staff.

This role requires strong critical thinking, decisive judgment, and the ability to work with minimal supervision.