Prior Authorization Specialist

Job Title: Prior Authorization Specialist

Job Code: (JW-BODB)

Position Type: Full-time

Work Hours: 8:00 AM - 5:00 PM Eastern Standard Time, Monday - Friday

Salary rate: $5-$7per hour

Key Responsibilities

• Gather clinical documentation, confirm medical necessity criteria, submit requests via payer portals (e.g., Availity), CoverMyMeds, fax, or phone.
• Monitor status queues daily, follow up within payer timelines, and manage renewals/reauthorizations proactively.

• Verify eligibility and benefits through online portals, clearinghouses, and outbound payer calls.

• Confirm and document: copays, deductibles, coinsurance, OOP max, plan type, effective dates, coverage limitations, and authorization/referral requirements.

• Flag and resolve discrepancies (inactive coverage, wrong member ID, plan mismatches) before service dates to prevent denials.
• Review EOB/ERA/denial message...