Prior Authorization
Prior Authorization is a common healthcare process where medical staff must get approval from insurance companies before certain treatments, medications, or procedures can be performed. It's like getting permission ahead of time to ensure the insurance will cover the costs. Medical offices need staff who understand how to handle these requests efficiently because they directly impact patient care and practice revenue. This process might also be called "pre-authorization," "pre-certification," or "pre-approval" in job descriptions.
Examples in Resumes
Processed 50+ Prior Authorization requests daily with 95% approval rate
Managed Pre-Authorization workflow for a busy cardiology practice
Reduced Prior Authorization processing time from 5 days to 2 days
Implemented new software system for tracking Pre-Certification requests
Typical job title: "Prior Authorization Specialists"
Also try searching for:
Where to Find Prior Authorization Specialists
Professional Organizations
Job Boards
Online Resources
Example Interview Questions
Senior Level Questions
Q: How would you handle implementing a new prior authorization system across multiple departments?
Expected Answer: Should discuss experience with change management, training staff, creating workflow procedures, and measuring success through metrics like reduced denial rates and processing times.
Q: How do you stay current with insurance policy changes and ensure your team maintains compliance?
Expected Answer: Should mention organizing regular training sessions, maintaining updated policy documentation, and having a system for communicating changes to staff.
Mid Level Questions
Q: What steps do you take when an authorization is denied?
Expected Answer: Should explain the appeal process, gathering additional documentation, working with healthcare providers, and following up with insurance companies.
Q: How do you prioritize multiple authorization requests?
Expected Answer: Should discuss organizing by urgency, procedure date, insurance requirements, and considering patient needs while managing deadlines.
Junior Level Questions
Q: What information is typically needed for a prior authorization request?
Expected Answer: Should list basic requirements like patient demographics, insurance info, diagnosis codes, procedure codes, and clinical documentation.
Q: How do you verify insurance benefits for a patient?
Expected Answer: Should explain checking insurance portals, making phone calls to verify coverage, and documenting benefit information accurately.
Experience Level Indicators
Junior (0-2 years)
- Basic insurance verification
- Data entry in medical software
- Phone communication skills
- Understanding of medical terminology
Mid (2-5 years)
- Managing complex authorization requests
- Knowledge of appeal processes
- Understanding of insurance policies
- Efficient workflow management
Senior (5+ years)
- Team leadership
- Process improvement
- Training and development
- Policy implementation
Red Flags to Watch For
- No knowledge of HIPAA compliance
- Poor attention to detail in paperwork
- Lack of experience with medical terminology
- Limited understanding of insurance requirements
- Poor communication skills
Related Terms
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