Prior Authorization Specialist - Medical Payer Liaison

AdventHealth; Chatsworth (GA); On-site; USD 22,000 - 35,000; Full time

Benefits offered by this job

Benefits from Day One

Parental Leave

Career Development

Well-being Resources

Job summary

AdventHealth in Calhoun, GA seeks a detail-oriented professional to manage prior authorizations and communications with payers. You will document medical necessity, verify patient data, and coordinate with clinical teams to ensure smooth approval processes.

The role emphasizes accurate EMR entry, HIPAA confidentiality, and collaboration across departments to maintain payment accuracy and timely service delivery.

Qualifications

• High School graduate or equivalent required.
• Experience reviewing documentation and ensuring compliance with payer guidelines is desirable.

Responsibilities

• Obtains prior authorization or pre-certification for services for payment by insurers, including CMS and state programs.
• Submits clinical documentation for payor approval and ensures medical necessity criteria are met.
• Acts as liaison with clinical care team to ensure payer guidelines compliance.
• Coordinates communication between business and clinical operations; verifies eligibility and benefits as needed.

Skills

Validation

Education

High School Grad or Equiv

Job description

AdventHealth in Calhoun, GA seeks a detail-oriented professional to manage prior authorizations and communications with payers. You will document medical necessity, verify patient data, and coordinate with clinical teams to ensure smooth approval processes.

The role emphasizes accurate EMR entry, HIPAA confidentiality, and collaboration across departments to maintain payment accuracy and timely service delivery.