Insurance Verification and Prior Authorization Specialist


Medical billing company located in Tempe, Arizona is seeking an Insurance Verification and Prior Authorization Specialist. As a critical member of our team, demeanor and confidentiality is a crucial aspect of this position. The candidate will be focused on obtaining prior authorization approvals from insurance companies for our providers across the country. The work environment will be in office and casual but extremely professional. This person will be an important member of our team and must be willing to perform a specific set of skills.

We are looking for a fun, positive person who is detail oriented and can multi-task with great energy. Previous medical billing experience and experience with a certified medical billing software is required. There is a tremendous opportunity for growth in our company.


Duties & Responsibilities:

·         Verify patients medical plan benefits and requirements according to their specific medical policy, to ensure necessary procedures are covered by an individual’s provider and maximum payment for services rendered.
·         Handle incoming and outgoing calls from internal team members, insurance payers and customers related to insurance benefits.
·         Identify important patient and demographic information that are missing and update information to avoid claim processing issues with the insurer.
·         Create or build charts for provider’s offices from faxed in documentation.
·         Determine if prior authorization and/or gap exception is required for ordered services.
·         Ensures appropriate clinical documentation is available and complete before submitting the prior authorization and/or gap exception.
·         Contact insurance companies to obtain patient’s medical benefits information and to start the prior authorization and/or gap exception.
·         Send clinical documentation to the insurance company for review and approval.
·         Follow up with insurance companies to ensure documentation has been received and prior authorization and/or gap exception is in process.
·         Obtain and review prior authorization and/or gap exception approval and upload approval documentation to the patient's chart.
·         Communicate to our providers that the approval is complete and patient is ready to be seen for services.
·         Ensure security and confidentiality of data and office technology.
·         Perform additional daily tasks and/or special projects as necessary.


·         General knowledge of insurance cards, medical insurance terminology, medical benefits, and CPT and ICD 9/10 coding.
·         Previous experience with a medical billing company in the accounts resolution or claim appeals department.
·         Previous experience with certified medical billing software.
·         Excellent interpersonal skills.
·         Attention to accuracy and detail in all aspects of responsibilities.
·         The ability to manage priorities and focus on completing tasks efficiently and within time frames.
·         Experience performing research utilizing the Internet.
·         Excellent organizational skills.
·         Experience implementing and managing organizational protocols.
·         The ability to follow directions, sometimes from multiple sources, and determine priorities.
·         Flexibility and a willingness to perform other reasonable duties as requested, including willingness and ability to stay late on occasion.
If you excel in the above requirements, please submit your resume with a brief cover letter and salary history for consideration.

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