Prior Authorization Utilization Review Jobs in Wisconsin

Description

Prior Authorization Specialist

Join a Team That Keeps Patient Care Moving Forward

Neuroscience Group is growing, and we're excited to expand our Prior Authorization team! We are seeking a full-time Prior Authorization Specialist to join our Clinical Services team. This position works Monday through Friday, 8-hour daytime shifts, with no nights, weekends, or holidays.

As a Prior Authorization Specialist, you'll play a vital role in helping patients receive timely access to the testing, procedures, and treatments they need. Working closely with providers, clinical staff, insurance companies, and patients, you'll ensure prior authorizations are obtained efficiently and accurately while helping remove barriers to care. If you enjoy solving problems, thrive in a fast-paced environment, and take pride in providing exceptional customer service, we'd love to hear from you.

About Neuroscience Group

For more than 30 years, Neuroscience Group has been the region's leader in comprehensive brain, spine, and pain care. As Northeast Wisconsin's only practice bringing together neurosurgery, neurology, orthopedic spine surgery, interventional and non-interventional pain management, and physical therapy, we are committed to improving lives through exceptional patient care.

Today, our team of more than 50 providers serves patients throughout the Fox Valley and Northeast Wisconsin across nine outreach clinics. Everything we do is guided by our core values.

When you join Neuroscience Group, you become part of a collaborative team that is committed to excellence-for our patients and for one another.

Requirements

What Do You'll

As a Prior Authorization Specialist, you will:

• Verify patient insurance coverage and maintain accurate demographic and insurance information.
• Review provider orders, medical documentation, CPT codes, diagnosis codes, and insurance requirements to determine authorization needs.
• Submit prior authorization requests through payer portals, fax, and telephone for diagnostic testing, procedures, and treatments performed both within Neuroscience Group and at outside facilities.
• Gather and upload supporting clinical documentation from Epic, Care Everywhere, and external medical records.
• Monitor pending authorization requests and proactively follow up to ensure timely approvals.
• Communicate authorization approvals, denials, and insurance requirements with patients, providers, and clinical teams.
• Coordinate peer-to-peer reviews between providers and insurance carriers when required.
• Assist providers with appeals by gathering documentation and supporting appeal submissions.
• Maintain accurate documentation and records to ensure continuity of patient care.
• Manage incoming and outgoing documentation through FaxFinder cloud faxing.
• Collaborate closely with physicians, clinical staff, reimbursement services, outside facilities, and fellow team members.
• Participate in department meetings and continuous process improvement initiatives.
• Perform additional duties as assigned.

What We're Looking For

Successful candidates will have:

• Previous experience with medical prior authorization or precertification.
• Working knowledge of commercial insurance, Medicare, Medicaid, Workers' Compensation, VA, and other third-party payers.
• Experience with CPT and ICD-10 coding.
• Previous Epic experience preferred.
• Strong understanding of medical terminology.
• Excellent organizational skills and exceptional attention to detail.
• Outstanding written and verbal communication skills.
• Strong customer service skills with a patient-first mindset.
• Critical thinking skills and the ability to prioritize multiple tasks in a high-volume environment.
• Proficiency with Microsoft Office and general computer applications.
• The ability to work both independently and collaboratively within a team.
• Physical Requirements
• Primarily seated work with occasional standing, bending, stretching, and reaching.
• Ability to lift supplies weighing up to 20-30 pounds.
• Occasional assistance with wheelchair transfers may be required.
• Ability to operate standard office equipment.
• Sufficient visual acuity, hearing, and manual dexterity to perform essential job functions.

Why Join Neuroscience Group?

We believe outstanding employees deserve outstanding benefits. In addition to a competitive compensation package, we offer:

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Health Savings Account with generous employer contribution
• Company-paid Life Insurance
• Company-paid Long-Term Disability Insurance
• Voluntary Short-Term Disability
• Voluntary Life Insurance
• Voluntary Accident and Critical Illness Insurance
• Competitive compensation based on experience
• 401(k) with guaranteed employer contribution
• Profit Sharing
• Cash Balance Pension Plan
• Generous Paid Time Off
• Separate Sick Leave Bank
• Employee Assistance Program
• Timber Rattlers tickets
• Employee Appreciation Day, Annual Summer Picnic, Holiday Celebration, Years of Service Recognition
• A supportive, collaborative workplace where your contributions make a meaningful difference every day.

If you're looking for an opportunity to combine your insurance knowledge, attention to detail, and passion for helping patients in a respected, physician-led specialty practice, we'd love to meet you. Apply today and become part of the Neuroscience Group team.