Prior Authorization Specialist — Medical Insurance & Denials

Granville-Health-System; Creedmoor (NC); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

PSLF eligible

Comprehensive benefits

Job summary

Granville Health System in Creedmoor, NC seeks a qualified Insurance Authorization Coordinator to manage prior authorizations for tests, procedures, and medications. You will verify coverage, track approvals, and communicate with patients and staff to ensure timely care.

Responsibilities include documenting activities, appealing denials when appropriate, and supporting referrals and eligibility verification in a HIPAA-compliant environment.

Qualifications

• High School Diploma or GED required.
• Minimum of two (2) years of experience in a healthcare setting involving insurance verification, prior authorizations, referrals, revenue cycle operations, patient access, medical office administration, or related responsibilities.
• Preferred: three (3) or more years of experience managing prior authorizations in primary care, family medicine, internal medicine, or multispecialty clinic environment.

Responsibilities

• Obtain and manage prior authorizations for diagnostic testing, specialty consultations, procedures, medications, durable medical equipment (DME), and other ordered services.
• Verify patient insurance eligibility, benefits, and coverage requirements prior to services.
• Review payer-specific requirements and ensure authorization requests are submitted accurately and timely.
• Monitor authorization status and proactively follow up with insurance carriers to prevent delays in patient care.
• Assess accounts for completeness and accuracy to support successful authorization approval.
• Communicate authorization requirements, approvals, denials, and status updates to patients, providers, and clinical staff.
• Maintain accurate tracking and documentation of authorization activity.
• Collaborate with providers and clinical staff to obtain supporting clinical documentation required for authorization requests.
• Obtain prior authorization approvals for prescribed medications.
• Investigate, track, and appeal authorization denials when appropriate.
• Submit supporting documentation, medical necessity information, and required forms to insurance carriers.
• Follow up on pending requests and communicate outcomes to patients and clinical staff.
• Appeal denials utilizing appropriate clinical documentation, coding information, and payer requirements.
• Monitor authorization and denial trends and communicate opportunities for process improvement.
• Verify patient insurance eligibility and benefits prior to appointments, services, and diagnostic testing.
• Maintain accurate and up-to-date insurance information within the electronic medical record.
• Identify coverage limitations and notify patients and providers of potential barriers to care.
• Serve as a resource to providers and staff regarding payer requirements and insurance guidelines.
• Assist with referral coordination and processing as operational needs permit.
• Support providers and clinical staff in facilitating referrals to specialists, ancillary providers, imaging centers, therapy services, and other healthcare resources.
• Communicate referral-related information to patients and external organizations as needed.
• Maintain accurate documentation of referral activity when assigned.
• Maintain complete, accurate, and timely documentation of all authorization, insurance, and referral-related activities.
• Ensure compliance with HIPAA regulations, payer requirements, and organizational policies.
• Document account activity and maintain audit-ready records.
• Perform additional duties and special projects as assigned by Practice Leadership.

Education

High School Diploma or GED

Job description

Granville Health System in Creedmoor, NC seeks a qualified Insurance Authorization Coordinator to manage prior authorizations for tests, procedures, and medications. You will verify coverage, track approvals, and communicate with patients and staff to ensure timely care.

Responsibilities include documenting activities, appealing denials when appropriate, and supporting referrals and eligibility verification in a HIPAA-compliant environment.