Prior Authorization Specialist - Fast-Track Patient Care

NEUROSCIENCE GROUP; Appleton (WI); On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Health Savings Account

Company-paid Life Insurance

Long-Term Disability Insurance

Voluntary Short-Term Disability

Voluntary Life Insurance

Voluntary Accident and Critical Illess

401(k) with employer contribution

Profit Sharing

Cash Balance Pension Plan

Paid Time Off

Sick Leave Bank

Job summary

Neuroscience Group is seeking a full-time Prior Authorization Specialist to join our Clinical Services team in Northeast Wisconsin. The role focuses on obtaining timely prior authorizations for tests, procedures, and treatments, working with providers, insurers, and patients to remove barriers to care.

Ideal candidates will have prior authorization experience, CPT/ICD-10 coding, strong medical terminology understanding, and proficiency with Epic.

Qualifications

• Experience with medical prior authorization or precertification.
• Working knowledge of commercial insurance, Medicare, Medicaid, and other payers.
• Experience with CPT and ICD-10 coding.
• Epic experience preferred.
• Strong medical terminology understanding.
• Excellent organizational and communication skills.

Responsibilities

• Verify patient insurance coverage and maintain demographic data.
• Review orders, documentation, CPT/ICD-10 codes to determine authorization needs.
• Submit prior authorization requests via payer portals, fax, and phone for tests and procedures.
• Gather and upload clinical documentation from Epic and external records.
• Monitor and follow up on pending authorizations for timely approvals.
• Communicate approvals, denials, and requirements with patients and teams.
• Assist with appeals by gathering docs and submissions.
• Maintain accurate records for continuity of care.
• Collaborate with physicians and staff across departments.

Skills

Prior authorization experience

Medical terminology

CPT/ICD-10 coding

Epic Systems

Excellent communication

Customer service

Teamwork

Tools

Epic Systems

Job description

Neuroscience Group is seeking a full-time Prior Authorization Specialist to join our Clinical Services team in Northeast Wisconsin. The role focuses on obtaining timely prior authorizations for tests, procedures, and treatments, working with providers, insurers, and patients to remove barriers to care.

Ideal candidates will have prior authorization experience, CPT/ICD-10 coding, strong medical terminology understanding, and proficiency with Epic.