Prior Authorization Representative

Job Description

Networks Connect is seeking a Prior Authorization Representative that will work in office. Networks Connect is conducting a search on behalf of our client, a prominent local Healthcare System. We are looking for a detail-oriented Prior Authorization Representative to support patient access by managing insurance verification, prior authorizations, and referral processes. This role plays a critical part in ensuring smooth patient care by reducing payor-related barriers and enhancing financial outcomes.

Why Join Us?

• Competitive salary and comprehensive benefits
• Growth opportunities within the healthcare industry
• Supportive and collaborative team environment
• Meaningful work that directly impacts patient care

Responsibilities:

• Manage pre-service payor clearance, ensuring prior authorizations and insurance verification are completed before services are provided
• Work with referring physician offices, insurance carriers, and patients to navigate prior authorization requirements
• Verify insurance eligibility, secure referrals, and ensure proper documentation for claims processing
• Address and resolve any insurance coordination of benefits (COB) issues before services are rendered
• Assist in obtaining approvals for add-on cases and update authorizations as needed
• Provide clinical information to insurance payors to streamline authorization approvals and minimize peer-to-peer reviews
• Educate providers and staff on payor guidelines and documentation requirements
• Track and report trends related to denials, appeals, and authorization approvals to improve efficiency
• Collaborate with internal departments, including Compliance, Patient Financial Services, and Case Management, to reduce claim denials

Qualifications:

• Education: High School Diploma or GED required; Associate or Bachelor’s degree in healthcare or business-related field preferred
• Experience: Minimum 2 years in healthcare registration, billing, insurance verification, prior authorization, or claims processing
• Skills:
  • Strong knowledge of medical and insurance terminology, including CPT and ICD coding
  • Excellent communication and customer service skills
  • Ability to multitask and problem-solve in a fast-paced environment
  • Proficiency with Electronic Medical Records (EMR) systems preferred
  • Bilingual candidates are a plus
  • Type 35+ WPM

Benefits:

• Competitive salary with performance incentives
• Health, dental, and vision insurance
• Paid time off and holidays
• Career advancement opportunities
• A positive and inclusive work environment

Apply today to become a vital part of our Client’s healthcare team!

Earnings

$45,000-$55,000 salary

Category

Revenue Cycle