Prior Authorization Specialist
On-site · Naples, Florida, United States
Job Summary
The Prior Authorization Specialist is responsible for obtaining timely insurance authorizations for procedures, imaging, and services across multiple specialties, reviewing clinical documentation for accuracy prior to submission, submitting requests through payer portals or other systems, tracking status and communicating approvals or requests for additional information to clinical and scheduling teams, verifying benefits and coverage requirements, maintaining documentation in EMR/billing systems, escalating denials or delays, staying current with payer guidelines, and collaborating with front desk, clinical, billing, and coding teams to support clean claims and reduce denials. This role may assist with appeals, ensure HIPAA/compliance, and contribute to operational excellence within a multi-specialty setting.
Required Qualifications
- High school diploma or equivalent
- associate degree preferred
- 1–2 years of experience in prior authorizations, referrals, or revenue cycle operations (healthcare required)
- Strong knowledge of insurance plans, payer requirements, and authorization workflows
- Experience with EMR/EHR systems and payer portals
- Familiarity with CPT, ICD-10, and medical terminology preferred
- Excellent organizational and communication skills
- Detail-oriented with ability to multitask in a fast-paced environment
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