Prior Authorization Specialist: Payer & Medications Support

Healing Strides Counseling; Bowling Green (KY); On-site; USD 25,000 - 33,000; Full time

Job summary

Healing Strides Counseling in Bowling Green, KY, seeks a detail-oriented Prior Authorization Specialist to verify patient eligibility and insurance benefits for clinic medications. You will secure authorizations, monitor renewals, and maintain documentation to support timely claims submissions.

The role requires strong knowledge of insurance terminology and medical terminology, with focus on accurate data entry, collaboration with clinicians, and adherence to payer guidelines.

Qualifications

• Prior experience in authorization processing and benefit investigation.
• Experience with specialty medication authorizations preferred.
• Strong attention to detail and accuracy.
• Proficiency in Microsoft Excel and related software applications.
• Ability to interpret insurance benefits, authorization guidelines, and medical terminology.
• High School or GED or better.

Responsibilities

• Initiate, monitor, and secure prior authorizations from third-party payers.
• Maintain electronic documentation for all prior authorization activities.
• Track pending authorizations and follow up within defined timeframes.
• Obtain authorization renewals and verify provider orders and medical necessity.
• Collaborate with clinicians and staff to obtain required notes and documentation.
• Verify authorization quantities and effective dates in billing systems.
• Review patient eligibility and plan requirements for clinic meds.
• Interpret payer guidelines to ensure approvals are documented.
• Input Payer Plan IDs and data into internal systems for billing.
• Determine patient financial responsibility and COB considerations.
• Organize workload and deadlines to prevent delays in claims.
• Maintain professional communication with payers and team members.
• Perform additional duties as assigned.

Skills

Authorization processing

Benefit investigation

Attention to detail

Time management

Interpersonal skills

Medical terminology

Education

High School or GED

Tools

Microsoft Excel

Job description

Healing Strides Counseling in Bowling Green, KY, seeks a detail-oriented Prior Authorization Specialist to verify patient eligibility and insurance benefits for clinic medications. You will secure authorizations, monitor renewals, and maintain documentation to support timely claims submissions.

The role requires strong knowledge of insurance terminology and medical terminology, with focus on accurate data entry, collaboration with clinicians, and adherence to payer guidelines.