Medical Prior Authorization Specialist - External Services

Job Description : Prior Authorization Specialist – External Services

Classification – FSLA : Non-Exempt Hourly

Salary Grade/Level/Range : Level of experience, longevity, within current company pay structure.

Reports to : Medical Assistant Manager

Summary/Objective This role is responsible for securing insurance authorizations for all diagnostic testing ordered by M.I.N.D. providers, including but not limited to MRIs, PET scans, DaT Scans, CT scans, and neuropsych testing. This role ensures timely and accurate processing of prior authorizations to support clinical workflow and minimize delays in patient care.

Essential Functions

Authorization Processing:

• Utilize insurance portals to initiate and manage prior authorizations for diagnostic procedures based on physician orders.
• Contact insurance companies to determine coverage and pre-authorization requirements.
• Submit necessary documentation (e.g., clinical notes, test orders, ICD-10 codes) for insurance review.

Communication & Coordination:

• Act as a liaison between providers, patients, insurance companies, and servicing facilities.
• Verify order accuracy including CPT codes, ICD10 billable diagnosis and request updates from providers as needed.
• Send orders to servicing facilities as requested.
• Notify providers and patients of authorization status, denials, or additional documentation needs.
• Reschedule or coordinate testing as necessary based on authorization outcomes.

Documentation & Recordkeeping:

• Maintain accurate records of all communications and authorizations in the electronic health record (EHR) system.
• Ensure all authorization approvals and reference numbers are properly documented before the testing date.
• Track and follow up on pending authorizations and appeal denials when needed.

Insurance & Compliance Knowledge:

• Stay current on insurance policies, payer-specific guidelines, and authorization procedures.
• Ensure compliance with HIPAA and patient confidentiality regulations in all communications and documentation.
• Comply with and adheres to all regulatory compliance areas, policies and procedures and company "best practices".

Qualities and Characteristics

• Maintains a professional relationship and positive attitude with co-workers, patients, and all M.I.N.D staff.
• Strives to learn more and receptive to new challenges and opportunities.
• Displays enthusiasm toward the work and the mission of M.I.N.D.
• Ability to organize, prioritize and handle multiple tasks, adhere to established deadlines, and produce work that consistently meets or exceeds benchmarks.
• Demonstrated strong work ethic with attention to detail, accuracy, and quality.
• Excellent organizational and time-management skills.

Qualifications

Required:

• High school diploma or equivalent
• 2+ years of experience in a medical office, preferably in neurology or diagnostic imaging
• Experience with insurance verification and prior authorization
• Knowledge of medical terminology, CPT and ICD-10 coding
• Basic computer proficiency and knowledge in the use of Microsoft applications.

Preferred:

• Associate’s degree or medical administrative certification
• Familiarity with EMR/EHR systems
• Strong understanding of neurology-related diagnostics and procedures

Work Environment

This job operates in a medical office facility.

Physical Demands

This position requires the ability to sit and view computer screens for long periods of time, and perform daily interactions with patients.

Position Type/Expected Hours of Work

This is a full-time position. Days and hours of work are Monday through Friday, varying hours between 8:00 a.m. to 4:30 p.m. Potential for remote work.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Employees should adhere to all approved policies, procedures, and philosophies.