The posting
About Us
At Alteva RCM, we're dedicated to helping healthcare providers thrive through expert revenue cycle management, strategic insight, and innovative solutions. We're always looking for passionate, driven professionals who want to make a meaningful impact, grow their careers, and be part of a collaborative team committed to excellence.
Role Description:
The Prior Authorization Specialist is responsible for managing the prior authorization process for surgical cases on behalf of multiple surgeons, medical practices, and healthcare clients. This role requires strong attention to detail, excellent communication skills, and the ability to manage multiple cases across different providers, payers, and specialties.
The Prior Authorization Specialist prepares, submits, tracks, and follows up on authorization requests to ensure cases are processed accurately and timely. This position serves as a key point of contact between the company, insurance payers, and client practices, providing regular updates on case status and helping ensure procedures are authorized before the scheduled date of service.
Key Responsibilities
- Prepare and submit prior authorization requests for surgical procedures and related services.
- Review case information to ensure all required documentation is complete and accurate before submission.
- Verify and confirm CPT codes, diagnosis codes, payer requirements, and authorization criteria.
- Submit cases through payer portals, fax, phone, or other required submission methods.
- Follow up with insurance companies to check authorization status, resolve pending issues, and obtain determinations.
- Track all submitted cases and maintain accurate, up-to-date case notes.
- Communicate case status, approvals, denials, requests for additional information, and delays to client practices in a timely and professional manner.
- Coordinate with client practices to obtain missing clinical documentation, updated codes, provider information, or other required details.
- Monitor upcoming surgery dates and prioritize cases based on urgency and payer turnaround times.
- Review payer responses and ensure authorization details match the requested procedure, CPT codes, facility, provider, and date of service when applicable.
- Escalate complex cases, urgent issues, peer-to-peer requests, denials, or documentation concerns as needed.
- Maintain confidentiality of patient information and comply with HIPAA and company policies.
- Support multiple client accounts while meeting productivity, accuracy, and turnaround time expectations.
Qualifications
- Experience with prior authorizations, insurance verification, surgical scheduling, billing, or medical office operations preferred.
- Familiarity with CPT codes, ICD-10 codes, insurance payer guidelines, and medical terminology.
- Ability to work with multiple provider practices, specialties, and insurance plans.
- Strong organizational skills and attention to detail.
- Excellent written and verbal communication skills.
- Ability to manage a high volume of cases and meet deadlines.
- Comfortable using payer portals, EHR/EMR systems, spreadsheets, and case tracking tools.
- Professional, dependable, and able to work independently in a fast-paced environment.
Ideal Candidate
The ideal candidate is detail-oriented, proactive, and comfortable communicating with both insurance companies and medical practice clients. They are able to keep cases organized, follow up consistently, and ensure clients are informed throughout the prior authorization process.
Pay Range
$60,000—$75,000 USD
Benefits
Alteva RCM offers our employees a comprehensive benefits package, including health, dental, vision, employee assistance plan, paid family leave, short-term disability and life insurance. We also provide a 401(k) plan with employer match, flexible spending accounts, employee discount program and an employee referral program.
