Prior Authorization Specialist - On Site

Tower Clock Eye Center is seeking a detail-oriented and proactive Prior Authorizations Specialist to support our clinical and revenue cycle operations. This role is responsible for obtaining timely prior authorizations and referrals for medical services across all insurance payers, ensuring patients can move forward with care without delays. The ideal candidate has strong insurance knowledge, excellent organizational skills, and thrives in a fast-paced healthcare environment. Key Responsibilities Review clinical documentation to confirm medical necessity and compliance with payer medical policy guidelines. Prioritize and manage incoming authorization requests based on urgency, appointment dates, and clinical need. Submit prior authorization requests through payer portals or by phone and follow up consistently on pending cases. Maintain accurate and up-to-date payer authorization reference files and requirements. Initiate and manage appeals for denied authorizations, including compiling supporting documentation. Act as a resource to clinic staff regarding payer medical policy and authorization requirements. Verify accuracy of CPT and ICD-10 codes associated with procedure orders. Communicate authorization status clearly and professionally with patients. Coordinate with referring physician offices to obtain additional documentation as needed. Enter and update patient demographics, insurance, and authorization data in practice management and EHR systems. Monitor provider schedules to proactively identify and resolve authorization or coverage issues. Complete required billing and authorization documentation to support clean claims submission. Perform other duties as assigned. Qualifications Education: High school diploma or GED required. Experience & Knowledge: Previous experience in medical billing, insurance verification, or prior authorizations required. Working knowledge of medical terminology. Familiarity with CPT and ICD-10 coding. Skills & Competencies: Strong attention to detail with excellent organizational and time-management skills. Ability to manage a high-volume, time-sensitive workload. Proficiency with computers, EHR/practice management systems, and Microsoft Office (Excel, Word). Excellent verbal and written communication skills. Strong customer service mindset with the ability to communicate professionally with patients, providers, and payers. Ability to work collaboratively and effectively in a team-oriented environment. Willingness to learn and participate in ongoing training and continuing education. Physical Requirements Ability to sit for extended periods of time. Ability to communicate clearly via telephone. Ability to view and enter data into computer systems. Manual dexterity sufficient to operate standard office equipment. Equal Opportunity Employer Tower Clock Eye Center is an Equal Opportunity Employer. In accordance with the Americans with Disabilities Act (ADA), reasonable accommodations will be provided to qualified individuals to perform the essential functions of this position. Applicants may request accommodations at the time of application. Job Type: Full-time Benefits: 401(k) Dental insurance Disability insurance Employee assistance program Employee discount Flexible spending account Health insurance Life insurance Paid time off Retirement plan Schedule: 8 hour shift Monday to Friday No weekends Education: High school or equivalent (Required) Experience: Insurance verification: 1 year (Required) Medical billing: 1 year (Required) Ability to Commute: Green Bay, WI 54303 (Required) Ability to Relocate: Green Bay, WI 54303: Relocate before starting work (Required) Work Location: In person