Prior Authorization & Eligibility Specialist

About AdvantixxRCM AdvantixxRCM is a healthcare revenue-cycle management company supporting medical practices and healthcare organizations with accurate, compliant, and service-focused billing operations. Our culture values ethical billing, patient-conscious service, accuracy, ownership, respectful collaboration, continuous improvement, privacy, security, and speaking up. Team members protect confidential patient and client information, use only authorized systems, and follow company, client, payer, HIPAA, and applicable legal requirements. AdvantixxRCM is an equal opportunity employer. Essential Duties & Responsibilities Verify patient insurance eligibility before scheduled services. Confirm active coverage and effective dates. Verify patient demographics and insurance information. Verify primary and secondary insurance coverage. Identify coordination-of-benefits issues. Verify provider participation/network status when appropriate. Review payer-specific requirements. Determine whether prior authorization is required. Determine whether a referral is required. Submit prior authorization requests. Obtain and submit supporting clinical documentation as required. Follow up with insurance companies regarding pending authorization requests. Track authorization status through determination. Document authorization numbers, effective dates, approved services/units, and expiration dates. Monitor existing authorizations to prevent expiration or exhaustion of approved visits/units.