We are looking for an experienced and detail-oriented **Medical Prior Authorization Specialist** to support a US-based healthcare practice. This role is responsible for securing timely insurance authorizations, ensuring compliance with payer requirements, and minimizing delays in patient care.
✨ Responsibilities
✅ Submit and manage prior authorization requests to commercial, Medicaid, and Medicare payers
✅ Review clinical documentation to ensure medical necessity requirements are met
✅ Follow payer-specific guidelines, policies, and turnaround times
✅ Track authorization status and perform timely follow-ups
✅ Communicate authorization approvals, denials, and requests for additional information
✅ Coordinate with providers, billing, and front-desk teams
✅ Manage peer-to-peer requests and appeal denials when required
✅ Maintain accurate authorization logs and documentation
✅ Ensure compliance with HIPAA and payer regulations
📌 Requirements
✔️ Minimum **2+ years of US prior authorization experience**
✔️ Strong knowledge of commercial insurance, Medicaid, and Medicare processes
✔️ Experience with CPT, ICD-10 codes, and medical necessity criteria
✔️ Familiarity with portals such as Availity, Navinet, Evicore, AIM, and payer-specific portals
✔️ Ability to manage high-volume authorization workloads
✔️ Strong attention to detail and follow-through
✔️ Excellent English communication skills (written & verbal)
...communication with passengers. Candidates should have a high school diploma, a valid Commercial Pilot License, and significant experience in flight operations, including 2,500 Pilot-in-Command hours. A strong focus on safety and effective communication is essential along with...
...a fast-paced environment and are committed to producing high-quality products. As a third shift worker, you will play a critical role in maintaining our production workflow during overnight operations, ensuring that performance goals are met with precision and safety.
...Job Responsibilities: Sa fely operate a company-provided Class B vehicle to deliver food and supplies to local restaurants.... ...regulations, and company policies. Qualifications: ~ Valid Class B drivers license with a clean driving record. ~2 years of verifiable...
...Summary The State of Wisconsin is seeking an experienced Database Administrator III to support the Wisconsin Department of Financial Institutions... ...and storage usage. Define and enforce user access levels for database segments, including insert, replace, retrieve,...
...and managing concerns. Passionate about design and up-to-date on current home trends. Job Description: Job Title: Home Stylist. Location: Greenville, SC. Reports To: Owner or Director of Home Staging. Employment Type: Full-Time. Position Summary...