Prior Authorization Specialist – Healthcare Coverage Expert

Healing Strides Counseling; Minneapolis (MN); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

401(k) plan

Paid time off

HSA plan

Job summary

Healing Strides Counseling in Minneapolis is seeking a Prior Authorization Specialist to support the business office by reviewing patient insurance information and preparing submissions for prior authorizations.

The role manages authorizations across Medicare, Commercial, Medicaid, and Worker's Compensation, coordinates with patients on pre-procedure requirements, and communicates with insurers, providers, and vendors while handling denials and appeals.

Qualifications

• High School Diploma or GED required.
• Associate's or Bachelor's degree preferred.
• Minimum of 1-year of prior authorization experience required in healthcare environment.
• Medical terminology preferred (CPT/HCPCS, ICD-10 Codes, Procedures, etc.).
• NextGen experience preferred.

Responsibilities

• Reviews patient insurance information to determine if treatments require prior authorization.
• Manages and processes Prior Authorizations for Medicare, Commercial, Medicaid, and Worker's Compensation.
• Identifies insurance coverage and coordinates with patients on pre-procedure requirements.
• Maintains knowledge of insurance prior authorization requirements, policies, and guidelines.
• Communicates with insurance companies, physicians' offices, outside vendors, and patients.
• Assists with authorization denials and appeals and tracks metrics as required.
• Cross-trains on other duties, including billing, as required.

Skills

Attention to detail

Communication skills

Problem solving

Independent work

Education

High School Diploma or GED

Associate's or Bachelor's degree preferred

Tools

NextGen

Job description

Healing Strides Counseling in Minneapolis is seeking a Prior Authorization Specialist to support the business office by reviewing patient insurance information and preparing submissions for prior authorizations.

The role manages authorizations across Medicare, Commercial, Medicaid, and Worker's Compensation, coordinates with patients on pre-procedure requirements, and communicates with insurers, providers, and vendors while handling denials and appeals.