Prior Authorization Specialist - Healthcare Admin (401k)

Socket.dev; Chandler (AZ); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Paid time off

Medical options

Health Savings Account

Dental & Vision Insurance

401(k)

Pet Discount Plan

ID Theft Protection

Job summary

OrthoArizona is seeking a detail-oriented Prior Authorization Specialist in Arizona to verify insurance authorization requirements for services and ensure accurate submission with CPT and diagnosis codes.

You will review documentation, coordinate with providers, and update EMR notes to support timely claims and patient scheduling. Excellent communication and healthcare admin experience are essential.

Qualifications

• Excellent customer / patient service.
• Knowledge of medical terminology.
• Excellent written and verbal communication skills.
• Understand/Perform training on practice management software.
• Ability to promote favorable facility image with physicians, patients, insurance companies, and general public.

Responsibilities

• Verify insurance authorization requirements for ordered services/procedures.
• Review documentation or contact the provider to supplement the order to prove medical necessity.
• Ensure appropriate documentation is available and complete before submitting the authorization to the insurance company to avoid repetitious submissions and denials.
• Submit all authorizations with correct CPT and diagnosis codes.
• Cross-reference the procedure against the doctor’s orders to ensure all services are submitted correctly.
• Enter authorization numbers and expiration dates into the EMR for proper claim processing.
• Update pertinent insurance notes in multiple EMR systems for corresponding departments to access.
• Monitors and resolves the status of problem authorizations.
• Faxes outgoing imaging orders to corresponding facilities and follows the order to ensure the patient is scheduled.
• Maintain medical records in accordance with practice policies and procedures.
• Estimates prepay amounts due for services and collects co-insurance, copays, deductibles or estimates self-pay rates; prepares daily batch, deposits, etc.

Skills

Customer service

Medical terminology

Verbal communication

Training on PM software

Healthcare administration

Education

High School diploma or GED

Job description

OrthoArizona is seeking a detail-oriented Prior Authorization Specialist in Arizona to verify insurance authorization requirements for services and ensure accurate submission with CPT and diagnosis codes.

You will review documentation, coordinate with providers, and update EMR notes to support timely claims and patient scheduling. Excellent communication and healthcare admin experience are essential.