Prior Authorization Specialist (Procedures)

About Us

At NextDimension AI, our mission is to simplify healthcare. We are a technology company building the next generation of AI-powered systems to automate complex workflows and create a more responsive, patient-centric experience. We have bold ambitions to reimagine healthcare, setting a new standard for how care is delivered and experienced across the industry. Our growing suite of AI solutions spans the Front Office, Clinical Operations, and Revenue Cycle Management.

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Healthcare's moment for AI-powered transformation is here, and we're building the technology to power it. Come join us in shaping the future of healthcare.

Role Description

As a Prior Authorization Specialist for Procedures, you will be a crucial link between our patients, our clinical team, and insurance carriers. Your primary responsibility will be to secure financial clearance for all office-based and hospital-based gastroenterology procedures, such as endoscopies, colonoscopies, and capsule endoscopies. You will manage a high volume of authorization requests, meticulously track their status, and ensure all necessary approvals are in place before the patient's scheduled service.

Key Responsibilities:

• Verify patient insurance eligibility and benefits for all scheduled GI procedures.
• Initiate, submit, and diligently follow up on prior authorization requests through insurance portals, phone, and fax.
• Gather and attach required clinical documentation (physician notes, lab results, imaging reports) to justify medical necessity.
• Communicate effectively with physicians, nurses, and scheduling staff regarding the status of authorizations.
• Document all activities and outcomes accurately in the patient's electronic health record (EHR).
• Address and resolve initial authorization rejections or requests for additional information.

Qualifications:

• Minimum of 2 years of experience in medical prior authorizations, specifically for surgical or medical procedures.
• Strong understanding of CPT (procedural) and ICD-10 (diagnostic) codes is required.
• Demonstrated experience navigating the portals of major medical insurance carriers (e.g., UnitedHealthcare, Aetna, Cigna, BCBS).
• Ability to read and interpret clinical documentation to extract information supporting medical necessity.
• Excellent organizational skills and the ability to manage a large caseload with competing deadlines.
• Experience in gastroenterology or surgical practice is highly preferred.