Prior Authorization Specialist I - CBO Prior Auth

Job Description

The Prior Authorization Specialist plays a critical role in supporting high-quality patient care by ensuring timely insurance verification and authorization for scheduled services. This position serves as a key liaison between patients, physicians, insurance carriers, and hospital departments to facilitate accurate and efficient authorization processes. The ideal candidate possesses strong analytical and organizational skills, a thorough understanding of insurance guidelines and managed care requirements, and a commitment to delivering exceptional customer service. Success in this role requires attention to detail, effective communication, and the ability to manage multiple priorities in a fast-paced healthcare environment while contributing to a positive patient experience.

Qualifications

KNOWLEDGE/EXPERIENCE:

• Sufficient experience to demonstrate ability to accept responsibility as a Hospital and Clinic prior authorization representative.
• Knowledge of anatomy and physiology, medical terminology and disease processes.
• Proficient keyboard skills and working knowledge of computer required.
• Good verbal and written communication skills.
• Cognitive, organizational and emotional abilities to deal effectively with multiple stressors, deadlines and customer needs.

EDUCATION: High school Diploma, HiSET or GED equivalent required. Completes Patient Financial Services I and training within first 5 months.