Prior Authorization Specialist: Streamline Complex Medical Approvals

Maryland Primary Care Physicians; Bowie (MD); On-site; USD 42,000 - 65,000; Full time

Job summary

Maryland Primary Care Physicians is seeking a Prior Authorization Coordinator to support patients, providers, and health plan representatives. The role focuses on obtaining authorizations, processing referrals, and ensuring accurate eligibility checks in a compliant, timely manner.

The coordinator will handle complex requests, enter data into systems, and collaborate with various departments to facilitate care across the network.

Qualifications

• 3–5 years’ experience in a medical office setting.
• Experience processing/referral or authorization requests in Utilization Management.
• Advanced data entry skills; fast and accurate.
• HIPAA compliance awareness and practice.

Responsibilities

• Obtain prior authorizations for diagnostic imaging, prescription medications, Home Health, and Durable Medical Equipment.
• Receives referral requests from providers and Health Plans representatives; assists in processing medical services requests.
• Verifies member’s eligibility and benefits; notifies staff of issues.
• Inputs all requests for services into the system for electronic authorization and tracking.
• Coordinates approved outpatient procedures with health plan authorization departments when applicable.
• Maintains logs, records, and reports as established.
• Adheres to HIPAA policies and protects PHI.

Skills

Data entry speed 45 wpm

Medical office experience

Utilization Management experience

Education

High school diploma or GED

Medical coding or authorization education/training

Job description

Maryland Primary Care Physicians is seeking a Prior Authorization Coordinator to support patients, providers, and health plan representatives. The role focuses on obtaining authorizations, processing referrals, and ensuring accurate eligibility checks in a compliant, timely manner.

The coordinator will handle complex requests, enter data into systems, and collaborate with various departments to facilitate care across the network.