Role Objective

We are seeking a detail-oriented Prior Authorization Specialist with a focus on Urology to join our team. You will be responsible for ensuring that all urological procedures, diagnostic tests, and medications are pre-approved by insurance carriers, minimizing denials and ensuring seamless patient care.

Key Responsibilities

Authorization Management: Submit and track prior authorization requests for urology-specific services, including cystoscopies, vasectomies, UroLift, and oncological treatments.

Clinical Review: Review patient charts and medical necessity documentation to ensure they meet payer-specific criteria.

Payer Communication: Proactively follow up with insurance companies (U.S.-based payers) via web portals and phone to expedite approvals.

Denial Prevention: Identify potential red flags in documentation that could lead to denials and collaborate with the clinical team to rectify them.