Benefits:

401(k)

Company parties

Competitive salary

Dental insurance

Health insurance

Paid time off

Vision insurance

Job Summary

The Prior Authorization Specialist is responsible for obtaining insurance approvals for gastroenterology services, including office visits, endoscopic procedures (colonoscopy, EGD), imaging studies, medications, infusions, and specialty treatments. The role serves as a liaison between patients, providers, insurance companies, hospitals, and pharmacies to ensure timely authorization and minimize delays in care.

Essential Duties

Verify patient insurance eligibility and benefits.

Determine whether prior authorization is required for procedures, medications, tests, or referrals.

Submit authorization requests through payer portals, fax, or phone.

Gather and review clinical documentation, physician notes, CPT codes, and ICD-10 diagnosis codes to support medical necessity.

Track pending authorizations and follow up with insurance companies.

Communicate approvals, denials, and additional documentation requests to providers, staff, and patients.

Document all authorization activity in the electronic medical record (EMR).

Coordinate with gastroenterologists, nurses, surgery centers, hospitals, pharmacies, and billing departments.

Assist with appeals and peer-to-peer reviews for denied services.

Maintain knowledge of payer policies, Medicare, Medicaid, HMO, and PPO requirements.

Required Skills

Knowledge of medical terminology, especially gastroenterology procedures.

Understanding of CPT, ICD-10, and insurance authorization processes.

Experience with EMR systems such as Epic, eClinicalWorks, NextGen, or Athenahealth.

Strong attention to detail and organizational skills.

Ability to manage multiple authorizations and deadlines simultaneously.

Excellent phone, written, and interpersonal communication skills.

Preferred Qualifications

High school diploma or GED (required by most employers).

Medical Assistant certification, billing/coding certification, or related healthcare experience preferred.

1–3 years of prior authorization, referral coordination, medical billing, or gastroenterology office experience.

Familiarity with specialty medications, infusions, and GI procedures.

3 Month probation period

Common Gastroenterology Procedures You May Authorize

Colonoscopy

Upper Endoscopy (EGD)

Capsule Endoscopy

ERCP

FibroScan

CT and MRI imaging

Biologic medications for Crohn's Disease and Ulcerative Colitis treatment.