Women’s Health CT is currently seeking a Full-time, Prior Authorization Specialists at Women’s Comprehensive Healthcare in Avon, CT!
Position: Prior Authorization Specialist
Location: Women’s Comprehensive Healthcare
Address: 20 West Avon Road, Suite 201, Avon, CT 06001
Employment: Full-time, 40 hours per week
Schedule: Monday- Friday, 8:00am- 4:30pm
Reports to: Practice Manager
Position Summary: The Prior Authorization Specialist is responsible for coordinating insurance benefit verification, prior authorizations, and patient financial responsibilities for surgical procedures, diagnostic imaging, specialty medications, and outpatient infusion referrals for Women’s Comprehensive Health Care. This position serves as a liaison between patients, providers, insurance carriers, and clinical departments to facilitate timely access to medically necessary services. Responsibilities include verifying surgical benefits, communicating estimated out-of-pocket expenses, coordinating prepayments, and obtaining authorizations for routine and urgent services. This role supports efficient clinical operations, patient financial transparency, and timely coordination of care.
Summary of Duties and Responsibilities:
- Verify insurance coverage, benefits, and authorization requirements for scheduled gynecologic or obstetric surgical procedures, including in-office and hospital-based surgeries.
- Determine patient financial responsibilities, including deductibles, copayments, coinsurance, and estimated out-of-pocket expenses associated with surgical services.
- Communicate estimated surgical costs and financial obligations to patients prior to their services, providing clear explanations of insurance benefits and anticipated expenses.
- Coordinate and collect surgical or obstetrical prepayments in accordance with practice policies, accurately documenting payments and patient communications.
- Obtain and track prior authorizations and pre-certifications for surgical procedures, ensuring approvals are secured prior to scheduled services.
- Process routine and STAT prior authorization requests for advanced diagnostic imaging, including CT scans and MRIs, to prevent delays in medically necessary care.
- Coordinate prior authorizations for specialty gynecologic medications, including Lupron and other medications requiring payer approval.
- Obtain required authorizations for specialty referrals and treatment services, including intravenous iron infusions and other prescribed outpatient therapies.
- Review payer-specific authorization requirements and gather necessary clinical documentation, diagnosis codes, procedure codes, and medical necessity information to support submissions.
- Collaborate with providers, nursing staff, surgical schedulers, and external specialty offices to coordinate authorization requests and facilitate timely patient care.
- Monitor pending authorizations, follow up with insurance carriers, and escalate delays, denials, or requests for additional documentation to appropriate clinical personnel.
- Coordinate peer-to-peer reviews and authorization reconsiderations with providers when required.
- Verify authorization accuracy, including approved services, CPT codes, rendering providers, service locations, and effective dates.
- Maintain accurate documentation of benefit verification, authorization approvals, patient financial estimates, prepayments, and payer communications.
- Communicate authorization statuses, patient financial obligations, and outstanding requirements to patients and relevant clinical or administrative departments.
- Maintain organized work queues, prioritize time-sensitive requests, and provide departmental leadership with updates on outstanding authorizations and financial clearance activities.
- Ensure compliance with HIPAA, patient confidentiality requirements, and organizational policies.
- Perform other related duties as assigned.
Qualifications and Requirements:
- High school diploma or equivalent required; associate degree in healthcare administration, medical billing, or a related field preferred.
- Minimum of 2 years of experience in medical prior authorizations, surgical benefit verification, insurance coordination, or patient financial services preferred.
- Prior experience in an OB/GYN, women’s health, surgical specialty, or multispecialty medical practice preferred.
- Strong computer proficiency, including EMR, insurance payer portals and web-based systems, with the ability to efficiently navigate multiple platforms and quickly learn new software and technology.
- Strong organizational skills and ability to prioritize urgent requests while managing multiple deadlines and ongoing authorization requirements.
- Excellent attention to detail, problem-solving skills, and accuracy in financial and clinical documentation.
- Strong written and verbal communication skills with the ability to coordinate effectively with patients, providers, insurance carriers, and external healthcare facilities.
- Ability to work independently, exercise sound judgment, and maintain accountability for assigned responsibilities.
- Travel to any other Women’s Comprehensive Health Care locations may be necessary upon request
Qualified candidates are encouraged to apply to learn more about all the position has to offer!
The Job responsibilities provided are intended to be a summary of the job duties. In no instance should the duties, responsibilities, and requirements included in a job description constitute as being all-inclusive. The Company and authorized management personnel reserve the right to review, change, add and/or delete duties, responsibilities, and requirements on a job description as necessary.