The Prior Auth specialist would be responsible for managing end-to-end prior authorizations, including reviewing clinical documentation, identifying the correct ICD and CPT codes, submitting requests through payer portals, tracking pending cases, following up proactively, handling denials and appeals when needed, and coordinating closely with schedulers and providers to prevent delays in care.
Key Responsibilities :
• Review clinical documentation for completeness
• Identify correct ICD-10 & CPT codes
• Submit requests via payer portals
• Track and manage pending cases
• Proactively follow up with payers
• Handle denials and prepare appeals
• Track authorization metrics
Skills Requirements
• Minimal coding experience (mostly submission)
• Experience reviewing clinical documentation for completeness and accuracy
• Experience submitting authorizations through payer portals and following up proactively
• Ability to manage pending cases, track metrics, and stay highly organized
• Experience handling denials and preparing appeals with supporting documentation
