Recruiter's Glossary

Examples: ERISA • DRG • POS

Prior Authorization

Term from Health Insurance industry explained for recruiters

Prior Authorization is a key process in healthcare insurance where approval must be obtained before certain medical services, medications, or procedures can be covered by insurance. It's like getting permission from the insurance company before proceeding with treatment. Insurance companies use this process to ensure treatments are medically necessary and cost-effective. This role involves reviewing medical documentation, applying insurance policies, and coordinating between healthcare providers and insurance companies. Similar terms include "pre-authorization," "pre-certification," or "pre-approval" - they all mean the same thing.

Examples in Resumes

Processed 100+ Prior Authorization requests daily with 98% accuracy rate

Managed Prior Authorization and Pre-certification processes for specialty medications

Supervised team of 5 Prior Authorization specialists handling insurance approvals

Streamlined Pre-authorization workflow reducing processing time by 40%

Typical job title: "Prior Authorization Specialists"

Also try searching for:

Prior Authorization Coordinator Pre-certification Specialist Insurance Authorization Specialist Medical Authorization Coordinator PA Specialist Healthcare Authorization Representative Insurance Verification Specialist

Where to Find Prior Authorization Specialists

Professional Associations

Job Boards

Professional Networks

Example Interview Questions

Senior Level Questions

Q: How would you handle a situation where a urgent prior authorization request is denied?

Expected Answer: Should demonstrate knowledge of appeals processes, ability to handle escalations, understanding of medical necessity criteria, and experience working with providers to gather additional documentation. Should mention knowledge of expedited review processes for urgent cases.

Q: What strategies have you implemented to improve prior authorization efficiency?

Expected Answer: Should discuss process improvements, team management, workflow optimization, and experience with authorization software. Should mention metrics tracking and how to reduce turnaround times while maintaining accuracy.

Mid Level Questions

Q: What information do you need to process a prior authorization request?

Expected Answer: Should list essential elements like patient demographics, insurance information, diagnosis codes, procedure codes, clinical documentation, and provider details. Should understand the importance of complete documentation.

Q: How do you stay current with insurance policies and authorization requirements?

Expected Answer: Should mention regular review of policy updates, attending training sessions, using available resources, and maintaining communication with insurance companies about requirement changes.

Junior Level Questions

Q: What is the basic process of prior authorization?

Expected Answer: Should explain the basic steps: receiving requests, verifying insurance coverage, checking if authorization is required, gathering necessary documentation, submitting to insurance, and communicating results.

Q: How do you ensure accuracy in prior authorization submissions?

Expected Answer: Should discuss double-checking information, following checklists, using reference materials, and asking for help when needed. Should mention importance of attention to detail.