Job description · Healthcare admin · Full-time
Prior Authorization Specialist job description
A prior authorization specialist secures payer approval for procedures, imaging, and medications before care is delivered. They gather documentation, submit requests, and follow up until a decision is made.
Responsibilities
- Identify services that require prior authorization
- Gather clinical documentation from the chart
- Submit requests through portals, fax, or phone
- Follow up on pending requests and record decisions
- Coordinate peer-to-peer reviews and appeals
- Notify clinic staff and patients of approvals or delays
Requirements
- Two or more years in prior authorization or utilization review support
- Understands medical terminology and payer criteria
- Organized tracking of many pending requests
- Persistent payer follow-up
- HIPAA compliance
Tools
- CoverMyMeds
- Payer portals
- Your EHR
- Excel or a tracking board
What success looks like after 90 days
- Every pending authorization tracked with next follow-up date
- Approvals secured before scheduled procedures
- Appeal outcomes logged
Screening questions
Ask these before you book an interview.
- Which specialties have you handled authorizations for?
- Which portals have you used?
- How many authorizations did you manage weekly?
- This is a full-time role working set hours each business day. Can you commit to that schedule?
Interview questions
- An MRI is scheduled tomorrow and the authorization is still pending. What do you do?
- What documentation do you include for a medication request?
- How do you track 50 pending requests?
- Walk me through an appeal you supported.
Hiring tip
Share your top payers' common requirements in a one-page guide. It speeds up ramp-up dramatically.
Prior Authorization Specialist hiring FAQ
What does a Prior Authorization Specialist do?
A prior authorization specialist secures payer approval for procedures, imaging, and medications before care is delivered. They gather documentation, submit requests, and follow up until a decision is made. Day to day, the role covers work such as: identify services that require prior authorization, gather clinical documentation from the chart, and submit requests through portals, fax, or phone.
How much does it cost to hire a full-time Prior Authorization Specialist from the Philippines?
We place a full-time Prior Authorization Specialist from the Philippines for $1,800 a month. Every candidate passes our top 2% vetting, starts within 14 days, and comes with a 1-week trial backed by a replacement or refund. The price is a flat monthly rate for a dedicated full-time hire.
What skills should a Prior Authorization Specialist have?
Look for: two or more years in prior authorization or utilization review support, understands medical terminology and payer criteria, organized tracking of many pending requests, and persistent payer follow-up. Common tools include CoverMyMeds, Payer portals, Your EHR, and Excel or a tracking board.
What should a Prior Authorization Specialist achieve in the first 90 days?
Every pending authorization tracked with next follow-up date, approvals secured before scheduled procedures, and appeal outcomes logged.
Can I copy and edit this Prior Authorization Specialist job description?
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Want us to find your Prior Authorization Specialist?
We place a full-time Prior Authorization Specialist from the Philippines for $1,800 a month. Every candidate passes our top 2% vetting, starts within 14 days, and comes with a 1-week trial backed by a replacement or refund.