The Prior Authorization (PA) Associate is responsible for obtaining timely and accurate insurance authorizations for medical procedures, diagnostics, and treatments to ensure reimbursement and prevent claim denials. This role collaborates with internal teams, providers, and payers to validate eligibility, secure authorizations, and resolve discrepancies while adhering to payer guidelines and compliance standards. The PA Associate plays a critical role in supporting revenue cycle performance by driving efficiency, maintaining accuracy, and ensuring timely turnaround of authorization requests. Success in this role requires strong attention to detail, knowledge of payer requirements, and the ability to manage multiple priorities in a fast-paced environment. Performs other duties as assigned.
Review, validate, and submit prior authorization requests for commercial, Medicare, and Medicaid payers.
Verify eligibility and ensure clinical documentation meets medical necessity requirements before submission.
Use payer portals, fax, and phone to obtain authorizations and follow up on pending requests within deadlines.
Communicate with providers, clinics, and vendors to gather missing documentation and streamline approvals.
Track and manage case inventory to meet productivity and quality goals, while documenting all activities accurately.
Identify trends in authorization denials or delays and escalate issues to leadership for resolution.
Maintain knowledge of payer portals, internal systems, and HIPAA compliance while handling sensitive patient data.
Collaborate with billing, denials, and clinical teams to improve workflows and support revenue cycle performance.
$15-$16/hr
Benefits include medical insurance, paid leave and holidays, and a 401K
Apply now to join our team.
Apply now to join our team.