Prior Authorization Specialist

We are looking for a detail-oriented individual to support front-end revenue cycle activities as a Financial Clearance Representative Associate focused on prior authorization. This Long-term Contract position plays an important role in helping patients and providers prepare for services by confirming coverage, securing approvals, and clarifying financial responsibility before care is delivered. The person in this role will work remotely during regular business hours, Monday through Friday, and collaborate with specialized teams that support areas such as cardiology, imaging, surgery, and specialty services.

Responsibilities:

• Assess scheduled patient services to determine authorization needs, review payer guidelines, and take the necessary steps to obtain approval before the date of service whenever possible.

• Verify insurance coverage and interpret plan benefits to confirm eligibility, service requirements, and expected patient cost obligations.

• Secure initial and follow-up authorizations within required timelines, while tracking status updates and addressing payer requests for additional information.

• Review clinical documentation and coordinate with care teams to gather the records needed to support authorization and financial clearance activities.

• Communicate denials, pending issues, or missing information promptly so accounts can be resolved before treatment and avoid delays in care.

• Prepare patient financial responsibility estimates and document benefit details accurately within the appropriate work queues and electronic systems.

• Maintain productivity and quality standards while managing a high-volume workload across assigned specialty areas in a remote team environment.

• Provide guidance to team members when needed on payer rules, revenue cycle questions, and policies that affect authorization workflows

Qualifications:

• High school diploma or equivalent is required.

• At least 6 months of experience handling prior authorization functions within an outpatient/surgery setting.

• Experience working directly with clinical staff and using clinical documentation to support authorization decisions is required.

• Knowledge of insurance verification, benefit interpretation, and patient financial clearance processes is required.

• Familiarity with commercial insurance, Medicare, and Medicaid plan structures is required.

• Strong written and verbal communication skills and the ability to work effectively in a productivity-driven environment are required.

• Understanding of medical terminology and healthcare procedures is required.

• Experience with Epic or another EMR/EHR platform, along with exposure to retail pharmacy or payer-related workflows, is preferred.

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.

Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app and get 1-tap apply, notifications of AI-matched jobs, and much more.

All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

© 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use and Privacy Notice.