Prior Authorization Specialist

The Staff Pad has partnered with a hospital in Las Vegas, New Mexico to find a dedicated Prior Authorization & Denials Coordinator to join their team.

Position Summary


The Prior Authorization & Denials Coordinator is responsible for managing prior authorizations for medical services, procedures, and medications, as well as overseeing denied claims to ensure timely reimbursement. This role serves as a liaison between healthcare providers, insurance companies, and patients-helping to ensure that authorization requirements are met and denials are resolved efficiently.

Key Responsibilities


Prior Authorizations

• Obtain prior authorizations for outpatient procedures, diagnostic testing, and specialty medications
  
• Verify insurance eligibility, benefits, and authorization requirements for scheduled services
  
• Communicate with insurance companies, physician offices, and patients to secure required documentation
  
• Track pending authorizations and follow up to ensure timely approvals
  

Denials Management

• Review and analyze denied claims to determine root causes and appeal opportunities
  
• Prepare and submit appeals with appropriate documentation and clinical justification
  
• Collaborate with billing, coding, and clinical teams to gather necessary information for appeals
  
• Track status and outcomes of appeals, maintaining organized records
  
• Maintain strict confidentiality of all patient and financial information
  

Communication & Coordination

• Provide updates to providers, staff, and patients regarding authorization and denial statuses
  
• Educate internal teams on authorization and denial best practices
  
• Serve as a subject matter expert for payer-specific policies and insurance guidelines
  

Compliance & Reporting

• Ensure compliance with payer policies, HIPAA, and regulatory standards
  
• Maintain accurate records and logs for audits and quality assurance
  
• Generate regular reports on authorization status, denial trends, and appeal outcomes
  

Qualifications


Education & Experience

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred
  
• Minimum of 2 years of experience in healthcare billing, utilization management, or a medical office setting
  
• Prior experience with authorization and denial management is strongly preferred
  

Skills & Competencies

• Knowledge of insurance carriers, medical terminology, and coding (CPT, ICD-10)
  
• Excellent organizational and multitasking skills
  
• Strong written and verbal communication abilities
  
• Proficient in EHR systems, practice management software, and Microsoft Office
  
• Detail-oriented with strong problem-solving and analytical skills
  

PandoLogic. Keywords: Prior Authorization Representative, Location: Las Vegas, NM - 87701