Job Description

We are seeking a detail-oriented and patient-focused Gastroenterology Prior Authorization Specialist to support our growing GI practice. This role is responsible for obtaining insurance authorizations for gastroenterology procedures, diagnostic testing, medications, infusions, and specialty treatments. The ideal candidate will have experience working with insurance carriers, medical terminology, CPT and ICD-10 coding, and prior authorization processes within a physician practice or healthcare setting.

The Prior Authorization Specialist serves as a liaison between patients, providers, insurance companies, and healthcare facilities to ensure timely approval of medically necessary services while providing an exceptional patient experience. [Prior Auth...cialist_JD | Word]

Key Responsibilities

• Obtain prior authorizations for gastroenterology procedures, including colonoscopies, endoscopies, capsule studies, imaging, laboratory testing, biologic therapies, and specialty medications.
• Verify patient insurance benefits, eligibility, coverage, deductibles, co-pays, and authorization requirements.
• Submit authorization requests and required clinical documentation to insurance carriers.
• Monitor authorization status and proactively follow up with payers to ensure timely decisions.
• Communicate authorization approvals, denials, and appeals requirements to providers, staff, and patients.
• Prepare and submit appeals and supporting documentation for denied services.
• Maintain accurate patient insurance and authorization records within the EMR and practice management systems.
• Collaborate with physicians, nurses, schedulers, billing staff, and infusion teams to coordinate patient care.
• Respond to patient inquiries regarding insurance coverage and authorization status.
• Ensure compliance with HIPAA and all payer-specific authorization guidelines.
• Track authorization turnaround times and assist with process improvement initiatives.
• Stay current on payer regulations, gastroenterology treatment guidelines, and authorization requirements.

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