Avance Care is elevating healthcare across North Carolina. As one of the state’s largest networks of independent primary care practices, we deliver comprehensive, patient-centered care that promotes physical, mental, and emotional well-being for every individual we serve.

We’re looking for a proactive Prior Authorization Specialist to join our care coordination team. In this role, you'll ensure the secure, accurate, and timely submission of insurance authorizations for specialist referrals, diagnostic imaging, and therapeutic services—while collaborating closely with patients, providers, and payers

The preferred candidate brings a strong grasp of medical necessity criteria, thrives in a fast-paced, team-oriented environment, and demonstrates exceptional attention to detail, communication skills, and knowledge of insurance workflows and regulatory standards.

Selected Responsibilities:

• Review patient medical records for current problem lists, medications, allergies, and documented diagnoses.

• Collaborate with providers and departments to prepare and submit prior authorization requests.
• Verify insurance eligibility and benefits, ensuring patients’ coverage is active before submission.
• Complete authorization forms, online portal entries, and verbal authorizations as needed.
• Track request status, document approval dates and reference numbers, and maintain accurate communication records.
• Follow medical necessity documentation workflows to expedite approvals and coordinate required follow-up.
• Process referrals and compile clinical support materials for insurance carriers.
• Communicate authorization updates and next-step instructions to patients, providers, hospitals, and diagnostic facilities.
• Investigate denials, prepare appeals upon physician request, and advocate for patients’ timely access to care.
• Monitor and report on key performance indicators related to prior authorization efficiency and accuracy.
• Provide education to patients, providers, and staff on authorization procedures, eligibility criteria, and appeal processes.
• Address and resolve issues arising during the authorization cycle, adhering to policies and timeframes.

Ideal candidates will bring a CMA (Certified Medical Assistant) or an LPN (Licensed Practical Nurse) and 1–2 years of experience handling prior authorizations and referrals.

Other Priorities:

• Ability to maintain confidentiality and uphold HIPAA compliance.
• Strong computer skills, including proficiency in EMR systems (EPIC strongly preferred) and Microsoft Office.
• Effective time management and workload prioritization.
• Strong multitasking abilities in a fast-paced environment.

If you’re passionate about ensuring patients receive the care they need without delay, we want to hear from you!

Avance Care provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to religion, race, creed, color, sex, sexual orientation, gender identification, alienage or citizenship status, national origin, age, marital status, pregnancy, disability, veteran or military status, predisposing genetic characteristics or any other characteristic protected by applicable federal, state or local law.