Prior Authorization Specialist

Job Description

Job DescriptionDescription:

At Functional Medicine of Idaho (FMI), we are committed to helping people thrive by providing personalized, integrative healthcare that addresses the root causes of health concerns. Our mission is to empower individuals at every stage of life, guiding them toward optimal well-being. We focus on delivering comprehensive, patient-centered care rooted in the latest research and compassionate service. At FMI, we value collaboration, innovation, and empathy, and are dedicated to offering the best functional and integrative medicine in the communities we serve. Join our team and be part of transforming healthcare while making a meaningful impact.

Benefits

• 401(k) with Employer Match
• Dental Insurance
• Employee Assistance Program
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off
• Employee Discounts on Wellness services, Supplements, & more!

Job Summary:
The Prior Authorization Specialist is responsible for coordinating, obtaining, and documenting prior authorizations for medical services, procedures, and medications to ensure timely patient care and accurate reimbursement. This role requires strong communication skills, attention to detail, and the ability to navigate payer requirements efficiently.

Key Responsibilities:

• Verify patient insurance coverage and eligibility.
• Review provider orders to determine if prior authorization is required.
• Submit prior authorization requests to insurance companies via phone, fax, or payer portals.
• Track, follow up, and document the status of all pending authorizations.
• Communicate authorization outcomes to providers, clinical staff, and patients.
• Collaborate with billing and clinical teams to resolve denials or delays.
• Maintain accurate records of all authorization activities in the practice
• Ensure compliance with payer policies and HIPAA regulations.
• Assist with appeals when authorizations are denied.
• Perform other related duties within the Billing Department as assigned, including but not limited to claim follow-up, payment posting, or insurance verification, to support overall departmental operations.

Work Environment & Schedule:

• Full-time position

Equal Opportunity Employer

Functional Medicine of Idaho is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, age, sex, marital status, national origin, ancestry, disability, handicap or veteran status.

Requirements:

FMIHIGHP