Remote Prior Authorization Specialist — Revenue Cycle Focus

Alliance Health System; United States; Hybrid; USD 50,000 - 55,000; Full time

Benefits offered by this job

401(k) matching

Health insurance

Paid time off

Paid Holidays

Job summary

Alliance Health System is seeking an Authorizations Specialist – Conservative to obtain prior authorizations for treatments by navigating payer portals, faxes, and calls. This role supports revenue cycle by ensuring timely authorizations in line with medical policies.

The position offers REMOTE or HYBRID work arrangements, and reports to the Director of Authorizations. Candidates should have at least 2 years of prior authorization experience, particularly with MD providers in Orthopedics & Pain

Qualifications

• High School Diploma or GED required.
• 2 years medical prior authorization experience preferred.
• 2 years experience with MD providers - Orthopedics & Pain preferred.

Responsibilities

• Review chart documentation to ensure policy adherence
• Prioritize authorization requests by urgency
• Obtain authorization via payer website, fax or phone and follow up regularly on pending submission
• Maintain payer files with up-to-date requirements needed to successfully obtain authorizations
• Initiate appeals for denied or modified authorizations
• Respond to clinic questions regarding payer medical policy guidelines
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Other duties as assigned

Skills

Authorization processes

Payer guidelines

CPT/ICD-10 codes

Excel

Customer service

Time management

Education

High School Diploma or GED

Tools

Microsoft Excel

Adobe

Internet/Web

Job description

Alliance Health System is seeking an Authorizations Specialist – Conservative to obtain prior authorizations for treatments by navigating payer portals, faxes, and calls. This role supports revenue cycle by ensuring timely authorizations in line with medical policies.

The position offers REMOTE or HYBRID work arrangements, and reports to the Director of Authorizations. Candidates should have at least 2 years of prior authorization experience, particularly with MD providers in Orthopedics & Pain