Prior Authorization Specialist Gastroenterology | Permanent WFH

We are seeking a highly organized and detail-oriented Prior Authorization Specialist – Gastroenterology to support a busy U.S.-based gastroenterology practice. The ideal candidate will be responsible for obtaining and managing insurance authorizations for GI procedures, diagnostic imaging, specialized testing, and laboratory services.

This role requires strong knowledge of insurance verification, payer authorization requirements, and prior authorization workflows. The successful candidate must be comfortable managing a high volume of authorization requests while ensuring accuracy, timely approvals, and uninterrupted patient scheduling.

Key Responsibilities

Prior Authorization Management

• Obtain and process prior authorizations for endoscopy procedures, imaging services, specialized gastroenterology testing, genetic testing, and laboratory work.
• Submit, track, and manage authorization requests through major insurance payer portals, including Availity, Blue Cross, UnitedHealthcare, and TRICARE Prime.
• Contact insurance providers directly to resolve pending authorizations, denials, and requests requiring additional documentation.
• Monitor authorization statuses and follow up proactively to prevent delays in patient care.
• Maintain accurate and updated authorization records in Modernizing Medicine (ModMed / Gastro GPM).
  
  

Insurance Verification & Patient Benefits

• Verify patient insurance eligibility, coverage, copayments, coinsurance, and deductibles.
• Identify authorization requirements and potential coverage limitations before scheduled procedures.
• Obtain and document patient financial responsibility information as part of the pre-authorization process.
• Ensure all insurance and authorization details are accurately recorded in the practice management system.
  
  

Workflow Coordination & Productivity

• Process approximately 50–100 authorization requests daily while maintaining accuracy and efficiency.
• Collaborate with internal scheduling teams to ensure patients receive timely authorization approvals before their appointments.
• Identify and escalate authorization issues that may affect scheduled procedures.
• Maintain organized documentation and ensure compliance with payer requirements and HIPAA regulations.
  
  

Qualifications

• 3–5 years of experience in medical prior authorization, preferably within gastroenterology or another specialty healthcare practice.
• Strong understanding of prior authorization processes for medical procedures, diagnostic imaging, and specialty testing.
• Hands-on experience with Modernizing Medicine (ModMed / Gastro GPM) is strongly preferred.
• Proficiency in navigating major insurance payer portals, including Availity, Blue Cross, UnitedHealthcare, and TRICARE Prime.
• Experience verifying insurance eligibility, benefits, copayments, coinsurance, and deductibles.
• Amenable to work during US hours
• Must be willing to undergo a background check as part of the hiring process.
  
  

Perks

• Permanent Work From Home
• Leave Credits
• Monetary Allowance
• Annual Bonus
• Weekly Paychecks
• Fixed Weekends Off
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary
  
  

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