THE ADVOCATE Prior Authorization Specialist

The Role

• Care cannot begin without authorization — your job is to get it approved the first time.
• In the Day Shift, you build the foundation for every approval by verifying eligibility, validating HCPCS codes, and assembling complete, submission-ready documentation. Every accurate submission prevents delays, denials, and rework.
• Your focus is simple: send it right the first time so it gets approved the first time.
  
  

• Eligibility & coverage verification — confirming patient criteria and prior authorization requirements for each HCPCS code
• Submission package assembly — compiling medical necessity documentation, physician orders, and all required supporting records
• Code validation — ensuring HCPCS codes align with payer-specific guidelines
• Checklist compliance — ensuring every submission meets standardized completeness criteria
• Handoff to Night Shift — preparing structured, accurate, and audit-ready authorization packages
  
  

• PRIOR AUTHORIZATION FIRST-PASS APPROVAL RATE
• TARGET: ≥ 90%
• Your work directly impacts this metric — the more accurate the submission, the higher the first-pass approval rate.
  
  

• The incomplete submission.
• Every denial caused by missing documentation, incorrect coding, or overlooked requirements starts here — before submission.
• Missing or incorrect documentation
• Process gaps that lead to rework and delays
  
  

• You are thorough before you submit — You check every detail before sending it forward
• You think in systems — You understand how each document impacts approval outcomes
• You own accuracy — You do not pass incomplete work to the next stage
  
  

• Full training in prior authorization processes, HCPCS coding, and documentation standards
• A clearly defined Day Shift role with measurable quality metrics
• Strong coordination with Night Shift for end-to-end process ownership
• Exposure to payer requirements and real-world authorization workflows
• A performance-driven culture focused on accuracy and outcomes
  
  

• Experience: 6 Months of experience in any field
• Education: Bachelor’s degree in any discipline
• Communication: Good verbal & written skills
• Analytical Skills: Basic ability to validate and review data
• Technical Skills: Basic MS Excel
• Attention to Detail: High accuracy in documentation and checklist-driven processes