Insurance Prior Authorization Representative

Our growing Gastroenterology practice is seeking a detail-oriented Insurance Pre-Authorization Representative to join our team at our Kingsport/Bristol location. This position plays a critical role in ensuring timely approvals for GI procedures, and diagnostic testing to prevent delays in patient care and reimbursement. The ideal candidate is organized, proactive, and experienced in insurance verification and authorization processes within a medical setting. Key Responsibilities Verify patient insurance eligibility and GI-specific benefits. Obtain prior authorizations and referrals for procedures including but not limited to: Colonoscopy (screening and diagnostic) EGD (Upper Endoscopy) Capsule endoscopy Motility studies Imaging and related diagnostic services Submit clinical documentation to meet medical necessity requirements. Track and follow up on pending authorizations. Coordinate peer-to-peer reviews when required. Communicate approval or denial status to providers, staff, and patients. Assist with appeals and re-submissions when necessary. Accurately document all activity in the EHR and practice management system. Support denial prevention and revenue cycle performance. Qualifications High school diploma or equivalent required. 1+ years of medical insurance verification or prior authorization experience (GI or procedural specialty preferred). Knowledge of CPT and ICD-10 coding. Understanding of preventive vs. diagnostic colonoscopy coverage is a plus. Experience with Medicare, Medicaid, and commercial payers. Strong organizational and communication skills. Ability to manage high-volume workload with accuracy. Job Type: Full-time Pay: $16.00 - $17.00 per hour Benefits: 401(k) matching Dental insurance Disability insurance Health insurance Life insurance Paid time off Vision insurance Experience: Pre-Authorization: 1 year (Required) Work Location: In person