Prior Authorizations Rep (30486)

GI Alliance; Glendale (AZ); On-site; USD 42,000 - 60,000; Full time

Job summary

Academic Urology & Urogynecology of Arizona is seeking a detail-oriented Authorization Specialist to review EMR messages, scheduling, and medical policy guidelines, ensuring timely approvals for upcoming surgical and in-office procedures.

You will verify coverage, obtain authorizations via payer portals or phone, follow up on pending cases, and communicate out-of-pocket obligations with patients, supporting efficient, compliant billing in a fast-paced environment.

Qualifications

• Minimum 1 year prior authorization experience.
• Understanding of payer medical policy guidelines to manage authorizations effectively.
• Proficient use of CPT and ICD10 codes.
• Detail-oriented and above-average organizational skills.
• Plans and prioritizes to meet deadlines.
• Ability to multitask and remain focused while managing a high volume, time-sensitive workload.
• Urology experience helpful.

Responsibilities

• Review EMR chart messaging and review schedules daily for upcoming surgical and in-office procedures.
• Review chart documentations to ensure patient meets medical policy guidelines.
• Prioritize authorization requests according to urgency.
• Obtain authorization via payer website or by phone and follow up regularly on pending cases.
• Verify coverage and benefits and calculate any out-of-pocket portions due.
• Contact patients to review any out-of-pocket portions due prior to surgery.

Skills

Prior authorization experience

Detail-oriented

Multitasking

Strong communication skills

Tools

CPT codes

ICD-10 codes

Job description

Description

Academic Urology & Urogynecology of Arizona is a premier urology practice offering compassionate patient care to individuals throughout Arizona.

Responsibilities

• Review EMR chart messaging and review schedules daily for upcoming surgical & in-office procedures
• Review chart documentations to ensure patient meets medical policy guidelines
• Prioritize authorization requests according to urgency
• Obtain authorization via payer website or by phone and follow up regularly on pending cases
• Verify coverage and benefits and calculate any out-of-pocket portions due
• Contact patients to review any out-of-pocket portions due prior to surgery

Qualifications

• Minimum 1 year prior authorization experience
• Understanding of payer medical policy guidelines to manage authorizations effectively
• Proficient use of CPT and ICD10 codes
• Detail-oriented and above-average organizational skills
• Plans and prioritizes to meet deadlines
• Ability to multitask and remain focused while managing a high volume, time-sensitive workload
• Urology experience helpful

Physical Requirements

Requires sitting for extended periods. Some bending, stretching, and stooping required. Manual dexterity enough to use a keyboard and calculator. Normal range of hearing and vision and verbal communication is required. Use of a telephone is required.

Performance Requirements

Knowledge of billing and insurance practices and procedures as well as regulations including Medicare, Medicaid, and third‑party insurance companies including managed care contracts. Knowledge of current ICD-10 and CPT codes is required. Strong communication skills are required.