Prior Authorization Specialist

Description

Job Overview:  The Authorization Specialist is responsible for pre-authorizing services including MRI, therapy, surgery, and durable medical equipment (DME) for the practice. This role includes verifying insurance benefits, obtaining pre-certifications and authorizations from payors, submitting necessary documentation, and assisting patients with understanding their financial obligations. The specialist will monitor the authorization status of scheduled patients and reschedule appointments as necessary pending completed authorization. 

Department: Administrative
Reports to: Prior Authorization Manager 

Schedule/Type: Full-Time M-F/ Hourly
Overtime Status: Non-exempt 

Wage: $20-32 per hour, commensurate with experience 

Requirements

Essential Job Responsibilities: 

• Submit and follow up on authorization requests with insurance companies for internal MRI, therapy, surgery, and DME orders.
• Verify order contents and insurance coverage upon receipt, obtain pre-authorization, and communicate benefits eligibility and financial details to patients and practitioners.
• Notify patients and practitioners of any services requested that are not authorized by insurance.
• Review upcoming schedules for authorization status and contact patients with payment/rescheduling options if authorization is not obtained.
• Utilize intraoffice communication and resources to support the authorization process.
• Prioritize workflow based on authorization timeframes, insurance requirements, and urgency.
• Obtain retroactive authorizations as needed.
• Maintain accurate and timely documentation and records for continuity of patient care.
• Perform other duties as assigned.

Education/Experience:

• High school diploma or GED required. College degree preferred.
• Minimum of 2 years of experience in billing/authorization preferred.
• Experience in an orthopedic or medical setting preferred.
• Familiarity with pre-authorization, pre-certification, and health insurance claims processing preferred

Performance Requirements:

• Knowledge of insurance processes, third-party payers, basic coding (CPT, ICD-9), Medicare compliance, OSHA, HIPAA, and relevant regulations.
• Skills in written and verbal communication, customer service, math, and organization.
• Ability to prioritize tasks, multitask, and work effectively in a fast-paced environment while maintaining cooperative relationships with staff and patients.

Benefits:

Company Paid Benefits

· Employee HDHP Plan

· Basic Life/AD&D –Guardian

· 16 days of PTO per year

· 7-7.5 paid holidays per year

· Employee Assistance Program

· 401(k) Safe Harbor Contribution

Benefit Options Requiring Employee Contributions

· Medical

· Health Savings Account

· Dental

· Vision

· Short-Term Disability

· Voluntary Life and AD&D

· Flex Spending Accounts

· General Purpose Healthcare FSA

· Optional Protection Benefits (Accident, Hospital Indemnity, Cancer Care and Critical Illness Insurance)

· 401(k)

Closing Date: May 15th, 2025   

Boulder Centre for Orthopedics is proud to be an Equal Opportunity employer. We are committed to providing equal employment opportunities to all qualified individuals without regard to race, color, religion, sex, national origin, age, disability, genetic information, marital status, sexual orientation, gender identity or expression, veteran status, or any other characteristic protected by applicable law. Our hiring decisions are based solely on qualifications, merit, and business needs. We encourage diverse candidates to apply and welcome the opportunity to build a talented and inclusive workforce. In our recruitment and employment practices, we adhere to applicable federal, state, and local laws, ensuring fairness and inclusivity in all aspects of employment. We value diversity and believe that a diverse workforce enhances our ability to serve our patients and community effectively. All qualified individuals are encouraged to apply, regardless of background or identity.