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TYPE OF WORK
Full Time
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SALARY
$5-$6
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HOURS PER WEEK
40
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DATE UPDATED
Feb 9, 2026
Prior Authorization Management
• Handle a high volume of prior authorization requests for medical services, procedures, and medications with accuracy and timeliness.
• Verify medical necessity against payer guidelines and clinical criteria, ensuring all required documentation is complete.
• Demonstrate strong follow?through on pending and denied authorizations, proactively resolving issues to avoid care delays or billing denials.
• Maintain an organized tracking system for authorization status, approvals, denials, and appeals to support compliance and audit readiness.
• Collaborate with providers, payers, and patients to secure approvals and communicate outcomes clearly.
• Apply knowledge of copay assistance programs to support patients in accessing needed therapies and reducing financial barriers
Claims Review & Adjudication
• Review claims for accuracy, medical necessity, and proper coding (CPT/HCPCS, ICD-10, modifiers, global periods).
• Identify missing info, duplicates, and audit flags.
• Apply MSO policies and payor guidelines; issue approvals, denials, or requests for more documentation.
• Communicate with clinic teams to resolve documentation issues.
Qualifications
• Required: Prior authorization experience
• 2+ years in prior authorization, utilization management, medical billing, claims adjudication, or revenue cycle.
• Strong knowledge of CPT, ICD-10, modifiers, medical necessity, and documentation.
• Experience in MSO, IPA, payor, or specialty practice preferred.
• Familiarity with capitation models and financial analytics valued.
• Detail-oriented, analytical, and strong communicator.
• EHR/PM experience (NextGen, DrChrono, ModMed, Epic, etc.) preferred.
• Excel/Google Sheets proficiency (VLOOKUP, pivot tables, formulas) preferred.
For interested applicants, please send your cover letters and resumes to Grace at
