Prior Authorization Specialist

We are looking for a Prior Authorization Specialist to support front-end revenue cycle activities for a long-term contract opportunity. This position plays an important role in helping patients move through the care process by confirming coverage, securing required approvals, and clarifying financial responsibility before services are delivered. The position requires strong knowledge of insurance processes, prior authorization workflows, and high-volume healthcare operations.

Responsibilities:

• Evaluate scheduled patient services and coverage details to determine when pre-service authorization or other financial clearance steps are required.

• Obtain initial approvals and follow-up authorizations within required timeframes to prevent delays in care or claim issues.

• Verify insurance eligibility, review benefit information, and interpret payer guidelines to support accurate account clearance.

• Calculate and communicate patient financial responsibility estimates based on plan coverage, benefits, and service details.

• Document authorization activity, verification findings, and account updates within EMR or EHR systems, preferably Epic.

• Work across assigned specialty areas such as cardiology, imaging, surgery, or other service lines based on business needs.

• Participate in daily remote team huddles and maintain productivity standards in a fast-paced, metrics-driven environment.

• Provide guidance to newer team members when needed on payer requirements, workflow expectations, and revenue cycle-related issues.

• Support additional work assignments related to financial clearance, insurance review, and pre-service account readiness as needed.

Qualifications:

• High school diploma or equivalent is required.

• At least 6 months of experience handling prior authorization activities in a healthcare setting.

• Background in front-end healthcare revenue cycle operations, including insurance verification and benefits review.

• Working knowledge of pharmacy benefits, medication-related coverage considerations, and patient financial estimates.

• Familiarity with commercial insurance, Medicare, and Medicaid plans and their authorization requirements.

• Ability to interpret medical terminology, clinical services, and procedural information accurately.

• Experience using EMR or EHR platforms; Epic experience is required.

• Proven ability to work effectively in a high-volume, productivity-focused remote environment.

Compensation

About Us

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

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