Authorization/Precertification Specialist

Job Description

Job Description

Description:

Mission:

Virginia Urology will provide access to individualized, quality, and compassionate urological care from a highly specialized and diverse teams while maintaining a fulfilling work environment.

Overall Objective:

The Authorization & Precertification Specialist is responsible for obtaining prior authorizations and precertification for medications, diagnostic testing, and surgical procedures across Urology, Oncology, and ASC services by verifying insurance benefits, submitting and tracking authorization requests, gathering required clinical documentation, coordinating with clinical and scheduling teams, communicating status updates to staff and patients, resolving denials, and ensuring all activities are accurately documented in the EHR.

Responsibilities Include:

• Obtain prior authorizations for medications, imaging, laboratory testing, radiation therapy, infusion treatments, and surgical procedures for Urology, Oncology, and ASC services.
• Complete precertification for ASC procedures, in-office surgeries, and hospital-based services according to payer requirements.
• Verify insurance eligibility and benefits for all scheduled services, confirming coverage levels, limitations, and authorization requirements.
• Submit authorization requests through payer portals, fax, or phone, ensuring accuracy and completeness of all information.
• Gather and prepare clinical documentation needed for medical necessity review, including provider notes, pathology reports, imaging results, and treatment plans.
• Communicate with providers, nurses, schedulers, and pharmacies to obtain missing information and clarify clinical details.
• Track and follow up on pending authorizations to ensure timely approval and prevent delays in patient care.
• Document all authorization and precertification activity in the EHR and practice management system.
• Notify staff and patients of authorization status, coverage issues, or anticipated out-of-pocket costs when appropriate.
• Assist with appeals and peer-to-peer requests when authorizations are denied or require additional review.
• Maintain current knowledge of payer policies, coding requirements (CPT/HCPCS/ICD-10), and authorization workflows.
• Collaborate with scheduling and clinical teams to ensure procedures are not booked without required approvals.
• Support billing and revenue cycle teams in resolving authorization-related claim denials or discrepancies.
• Performs other duties as assigned in support of clinical excellence, operational effectiveness and patient-centered care.

Minimum Knowledge, Skills, Abilities, and Experience:

• High school diploma or equivalent required.
• 1–2 years of experience in prior authorizations, precertification, insurance verification, or related revenue cycle work.

Desirable Knowledge, Skills, Abilities and Experience:

• Training in medical office administration or healthcare billing preferred.
• Knowledge of medical terminology, CPT/HCPCS, and ICD-10
• Experience with Medicare, Medicaid, and commercial plans
• Strong communication skills with the ability to interact professionally with providers, clinical staff, patients, and insurance representatives.
• Experience using EHR systems and payer portals to submit and track authorizations. Such as Availity, Cover My Meds, Evercore
• Excellent attention to detail and accuracy when reviewing documentation and entering data.
• Ability to prioritize and manage multiple requests in a fast-paced clinical environment.
• Problem-solving skills for navigating denials, appeals, and complex payer requirements.
• Basic understanding of surgical scheduling workflows, particularly for ASC procedures.

Physical Requirements:

• This position requires the ability to perform essential job functions in an office environment. The employee must be able to sit for extended periods while working at a computer and alternate between sitting and standing as needed.
• The role involves frequent keyboard use, repetitive hand motions, and precise visual acuity for reviewing documentation and entering data accurately.
• The position may require occasional walking, standing, reaching overhead, stooping, or bending to retrieve files or access office equipment.
• The employee must be able to lift and carry up to 20 pounds occasionally, such as moving office supplies or small equipment. No exposure to hazardous environments or extreme conditions is expected

Other Information:

A successful incumbent will exhibit strong initiative, personal accountability, and ability to independently identify and execute improvement opportunities.

This position is full-time, 40 hours per week, and will work Monday through Friday 8:00 am to 4:30 pm at our Southern States office located at 6606 West Broad Street, Richmond, VA 23230.

Full benefits package includes competitive compensation, health insurance, PTO, retirement plan and personal development support.

We are an Equal Opportunity Employer and are committed to a diverse and inclusive workplace.