Prior Authorization Specialist

Responsible for pre-authorizing ancillary testing and treatment, verify insurance benefits for precertification, initiate prior authorization via portal, fax, or telephone; review CPT/Diagnosis codes for accuracy; review patient chart documentation and external records to gather required information; determine necessity for pre-authorization for each CPT code; regularly follow up on pending requests; notify patients and practitioners of services not authorized; review denied cases for additional information and guide next steps (peer-to-peer or appeals); collaborate with provider on completion of appeal letters; maintain timely documentation and effective communication with patients, physicians, and staff; employ EPIC and Care Everywhere systems for efficient authorization workflow; manage high-volume, time-sensitive workload with strong organizational and analytical skills.