Prior Authorization Specialist

Logan Health

Prior Authorization Specialist at Logan Health ensuring smooth prior authorization process for healthcare claims. Collaborating with teams to expedite insurance authorizations and maintain HIPAA compliance.

Posted 7/29/2026full-timeRemote • Arizona, Colorado, Florida, Hawaii, Idaho, Illinois, Kansas, Minnesota, Missouri, Montana, North Carolina, Ohio, Oregon, Tennessee, Texas, Virginia, Washington • 🇺🇸 United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in obtaining prior authorizations, managing CPT and ICD-10 coding, and ensuring HIPAA compliance while effectively communicating with stakeholders. Proficient in handling retro authorizations, resolving denials, and maintaining accurate patient account records.

Highest-signal resume keywords

Prior Authorization ManagementCPT and ICD-10 CodingHIPAA ComplianceMedical Billing ExperienceStrong English Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

CPT CodingICD-10 CodingMedical TerminologyPrior AuthorizationsInsurance RequirementsReimbursement ProceduresAttention to DetailTask PrioritizationMedical BillingRetro Authorizations

Soft Skills

Strong Organizational SkillsExcellent Interpersonal SkillsAbility to Work IndependentlyTeam CollaborationProfessionalism

Tools & Technologies

Microsoft OfficeMeditech

Industry Keywords

HIPAA RegulationsManaged Care CoverageCommercial InsuranceGovernment InsurancePre-Certifications

About the role

Key responsibilities & impact

Obtain prior authorizations for facility and professional charges following departmental protocols.
Submit CPT and HCPCS codes and medical records to insurers to expedite authorizations.
Verify patient demographics and medical details, ensuring HIPAA compliance.
Review and confirm all supporting documents and collaborate with necessary stakeholders.
Prioritize authorization requests and ensure the accuracy of CPT and ICD-10 codes.
Maintain intranet resources related to payer requirements for prior authorizations.
Notify patients or clinics if authorization is not secured before service dates.
Handle retro authorizations, resolve denials, and manage appeals as needed.
Track all actions and update patient accounts accurately.
Communicate issues like billing concerns, backlogs, and documentation needs to leadership.
Adapt to changing circumstances to support patient flow.
Maintain professionalism, integrity, and confidentiality in all interactions.

Requirements

What you’ll need

2+ years of experience in a hospital, specialty clinic, or medical billing setting focused on pre-certifications or prior authorizations.
Knowledge of commercial and government insurance requirements, ICD-9/CPT codes, medical terminology, and HIPAA regulations.
Familiarity with Microsoft Office and willingness to learn new software.
Strong English communication skills, both written and verbal.
Associate or Bachelor’s degree preferred.
Experience with Meditech preferred.
Knowledge of managed care coverage, medical coding, and reimbursement procedures preferred.
Strong organizational skills, attention to detail, and task prioritization.
Ability to work independently and as part of a team.
Excellent interpersonal skills to handle confidential information professionally.

Benefits

Comp & perks

Opportunities for growth
Comprehensive benefits