Eligibility and Prior Authorization Specialist

Hera Women's Health
San Tan Valley, AZ

My obgyne is seeking a detail-oriented and knowledgeable Eligibility and Prior Authorization Specialist to join our practice. The ideal candidate will be responsible for verifying patient benefits and ensuring compliance with insurance guidelines.

Responsibilities:
  • Verify patient insurance benefits and coverage for OBGYN services in clinic.
  • Obtain prior authorizations and pre-certifications for treatments as required by insurance providers.
  • Communicate with insurance companies, patients, and healthcare providers to resolve any authorization or benefits-related issues.
  • Maintain accurate records of authorizations, approvals, and denials in the electronic health record (EHR) system.
  • Educate patients about their insurance benefits, coverage limitations, and out-of-pocket costs.
  • Work closely with the billing department to address claim denials related to authorization issues.
  • Stay up to date with insurance policies, coding changes, and payer requirements.
  • Provide administrative support to the practice as needed, including scheduling and coordinating patient services.
Requirements:
  • Minimum of 1 year of experience in completing prior authorization for a medical facility; PREFERRED in an OBGYN or women’s health setting.
  • Medical Assistance experience PREFERRED
  • Strong understanding of insurance policies, prior authorization processes, and medical billing.
  • Proficiency in electronic health records (EHR) preferably AthenaOne.
  • Excellent communication and customer service skills.
  • Strong attention to detail and ability to work efficiently in a fast-paced environment.
Benefits:
  • Salary based on experience
  • Health, dental, and vision insurance
  • Life insurance
  • 401(k) with employer matching after 1 year of service
  • Paid time off (PTO) and holidays

Posted 2025-09-29

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