Medical Insurance Prior Authorization Specialist

Lee Obstetrics and Gynecology is committed to our mission of providing quality, attentive, responsive care for the women of Lee County and the surrounding area. To put the patient’s health and well-being first and promote women’s health in all that we do. We are seeking a highly organized, detail-oriented Medical Insurance Prior Authorization Specialist to join our OBGYN practice.

This position is responsible for managing the prior authorization process for obstetric and gynecologic services, procedures, diagnostic testing, and surgical services.
The Prior Authorization Specialist will work closely with providers, surgery scheduling, billing staff, patients, and insurance companies to ensure required authorizations are obtained accurately and within the appropriate timeframe.

The ideal candidate is knowledgeable about health insurance requirements, comfortable communicating with insurance companies, and able to manage multiple time-sensitive requests while maintaining a high level of accuracy.
Hours are Monday - Thursday 7:45 am - 5:00pm CT, Friday 7:45am - 5:00pm CT in our Auburn, Alabama office

Essential Duties & Responsibilities
Verify patient insurance eligibility and benefits when necessary.
Determine whether OBGYN services and procedures require prior authorization.
Review insurance plans for authorization requirements and payer-specific guidelines.
Obtain and review necessary clinical documentation from providers and clinical staff.
Submit prior authorization requests through payer portals, fax, telephone, and any other required methods.
Obtain authorizations for services including, but not limited to:
Obstetric and gynecologic procedures
Surgical procedures
Diagnostic testing
Infertility-related services when applicable
In-office procedures
Other services designated by the patient’s insurance plan
Track all pending authorization requests and follow up with insurance companies in a timely manner.
Record authorization numbers, approval dates, expiration dates, approved services, units, and other pertinent information.
Ensure authorization information is accurately documented in the patient’s account and/or electronic medical record.
Communicate authorization status with providers, nurses, surgery schedulers, billing staff, and patients as appropriate.
Notify appropriate staff immediately when an authorization is denied, delayed, or requires additional clinical information.
Request additional documentation from clinical staff when required by the insurance company.
Assist with insurance denials, reconsiderations, appeals, and peer-to-peer requests related to prior authorization.
Monitor authorization expiration dates and obtain extensions or new authorizations when necessary.
Ensure approved services correspond with the correct procedure, diagnosis, provider, facility, and date of service when applicable.
Identify authorization-related issues that could result in claim denials or delays in patient care.
Maintain accurate and organized authorization records.
Maintain confidentiality and comply with HIPAA and practice policies.
Stay current with changes to insurance plans, payer requirements, authorization procedures, and OBGYN services.
Perform other billing and revenue-cycle duties as assigned.

OBGYN-Specific Responsibilities
The Prior Authorization Specialist should develop a strong working knowledge of authorization requirements related to:
Gynecology
Office procedures
Ultrasounds and diagnostic testing
Colposcopy and related procedures
Endometrial procedures
Hysteroscopy
D&C procedures
Ablation procedures
Incontinence procedures
Pelvic floor procedures
Gynecologic surgeries
Other procedures requiring payer authorization

Qualifications
High school diploma or equivalent required.
Previous experience in medical insurance,…