Prior Authorization Specialist: Expedite Approvals & Appeals

Slocumcenter; Eugene (OR); Remote; USD 50,000 - 70,000; Full time

Job summary

A healthcare facility is seeking a Prior Authorization Specialist in Eugene, Oregon. This role involves managing insurance approvals for medical and ancillary services while ensuring accurate submissions of clinical documentation. The ideal candidate will have 2 to 5 years of relevant experience and strong skills in medical billing, communication, and problem-solving. The position requires familiarity with insurance payer guidelines and the ability to collaborate effectively across departments.

Qualifications

• Strong understanding of medical terminology, ICD-10, CPT, and HCPC coding.
• Ability to manage high-volume workflows and mentor team members.
• Familiarity with CMS and insurance payer guidelines.

Responsibilities

• Submit and manage prior authorization requests for medical services.
• Research and resolve authorization and referral claim denials.
• Collaborate to analyze denied claims and provide corrected data.

Skills

Prior Authorization expertise

Medical billing knowledge

Strong communication skills

Attention to detail

Problem-solving skills

Education

2 – 5 years of experience as a Prior Authorization Specialist

Tools

NextGen

Microsoft Office Suites

Job description

A healthcare facility is seeking a Prior Authorization Specialist in Eugene, Oregon. This role involves managing insurance approvals for medical and ancillary services while ensuring accurate submissions of clinical documentation. The ideal candidate will have 2 to 5 years of relevant experience and strong skills in medical billing, communication, and problem-solving. The position requires familiarity with insurance payer guidelines and the ability to collaborate effectively across departments.