Prior Authorization Specialist

Pinnacle Fertility is the nation's fastest-growing physician-centric fertility care platform, supporting high-performing fertility clinics and comprehensive fertility service providers nationwide. Under a united mission of fulfilling dreams by building families, Pinnacle clinics offer innovative technology and processes, compassionate patient care, and comprehensive fertility treatment services, ensuring families receive a high-touch experience on their path to parenthood. Learn more at www.pinnaclefertility.com.

We are seeking a detail-oriented and highly skilled Prior Authorization Specialist to join our team. This individual will play a critical role in securing pre-certifications and prior authorizations for fertility-related procedures, working closely with insurance companies, healthcare providers, and patients. The ideal candidate has strong attention to detail, excellent communication skills, and a deep understanding of insurance processes and regulatory compliance.

This is a full-time, remote position.

Key Responsibilities

• Insurance Verification: Confirm patient insurance coverage and benefits, including requirements for prior authorizations.
• Authorization Requests: Submit accurate and comprehensive prior authorization requests to insurance companies, including all necessary medical documentation.
• Insurer Communication: Communicate with insurance companies to gather required information, clarify coverage limitations, and follow up on pending authorization requests.
• Regulation Compliance: Stay updated on insurance regulations and guidelines to ensure timely and accurate submission of prior authorization requests.
• Record Maintenance: Maintain detailed records of prior authorization activities, including patient information, insurance details, and approval statuses.
• Collaboration with Billing: Work closely with the billing department to ensure accurate coding and billing practices based on prior authorization approvals.
• Administrative Support: Perform additional administrative tasks and duties as assigned to support the prior authorization process.
• Other duties assigned
  
  

Position Requirements

• Minimum of 2 years of experience in a similar prior authorization role.
• Understanding of medical terminology, billing codes, and healthcare insurance policies.
• Strong attention to detail to ensure accuracy in data entry and prior authorization requests.
• Excellent verbal and written communication skills to effectively interact with multiple stakeholders.
• Problem-solving ability to navigate insurance processes and resolve prior authorization challenges.
• Technical proficiency, including basic typing skills and familiarity with electronic health record (EHR) systems and insurance payer portals.
• Experience with nAble EMR is a plus.
• Self-motivated and able to work independently, as well as collaboratively in a team environment.
  
  

Compensation & Benefits

• Salary Range: To be determined. Final offers will be based on experience, skills, and qualifications.
• Benefits: Comprehensive healthcare, dental, life, and vision insurance. Additional benefits include generous paid time off (PTO), paid holidays, and a retirement savings program. Further details will be provided during the interview process.
  
  

Diversity & Inclusivity at Pinnacle Fertility

At Pinnacle Fertility, we celebrate and value diversity. We serve everyone, regardless of gender, sexual orientation, race, ethnicity, or religion. Just as we embrace the diversity of our patients, we foster an inclusive work environment where team members feel supported and empowered. We are proud to be an equal-opportunity employer and encourage applicants from all backgrounds, abilities, and life experiences to apply.