Prior Authorization Specialist

Responsibilities

• Call insurance companies to verify coverage (PPO and HMO) and obtain benefit details
• Submit, track, and manage prior authorizations to ensure documentation meets payer requirements
• Coordinate with clinics and Practice Managers on medication timelines and patient scheduling
• Track medication inventory levels and initiate purchase orders to prevent shortages
• Monitor reimbursement success rates and collaborate with billing teams to resolve denials
• Verify all necessary authorizations are in place prior to medication administration

Requirements

• 2+ years of experience in healthcare administration, medical billing, or inventory management
• Familiarity with buy-and-bill processes for medications
• Strong understanding of insurance prior authorizations and reimbursement policies
• Knowledge of healthcare compliance regulations such as HIPAA
• Proficiency in medical software systems and Microsoft Office Suite
• Excellent organizational and multitasking skills

Preferred Qualifications

• Bachelor's degree in healthcare administration or business
• Medical or medical assistant background
• Relevant certifications such as Certified Medical Assistant or Billing Specialist
• Experience with automation or tech integration projects

Benefits

• Medical, dental, and vision insurance
• 401(k) retirement plan with employer matching
• Paid Time Off (PTO), sick time, and floating holidays
• Professional development opportunities

About the Company

Modena Health and Modena Allergy & Asthma are leading medical practices specializing in allergy, asthma, and immunology care. They are physician-led, hospitality-focused, and technology-enabled, committed to transforming allergy care through innovative solutions and compassionate patient-centered care.