Clinical Prior Authorization Specialist

The Clinical Prior Authorization Specialist will coordinate and obtain prior authorizations for medical services, diagnostic tests, procedures, and medications. Responsibilities include reviewing clinical documentation to determine medical necessity and payer requirements, communicating with providers to gather information, and documenting all authorization activities in the EHR. The specialist will monitor pending authorizations, follow up for timely approvals, notify stakeholders of outcomes, and assist with appeals when necessary. They will also collaborate with billing and scheduling teams, maintain knowledge of payer rules and regulatory changes, and track authorization metrics to reduce delays in care and support the revenue cycle.