Apex Medical Center is currently seeking a Medical Prior Authorization Specialist to join our team in Las Vegas, NV 89106.

Who We Are:

• Apex Medical Center is a comprehensive practice and offers services beyond pain management. Patients from the greater Las Vegas area turn to the Apex Medical Center team for help with many different medical conditions, including diabetes, allergies, gastrointestinal issues, skin ailments, and more.

What You’ll Do:

• Authorization Requests: Submit and manage prior authorization requests to insurance companies for various medical services, including surgeries, procedures, and medications.
• Documentation: Collect and review necessary medical documentation from healthcare providers to support authorization requests. This includes medical records, treatment plans, and clinical notes.
• Insurance Verification: Verify patients’ insurance coverage and understand the specific requirements for prior authorization of the insurer. This may involve direct communication with insurance companies to clarify coverage details.
• Patient Communication: Inform patients about the authorization process, including any potential delays in treatment due to pending authorizations. Assist patients with questions about their insurance coverage and the status of their authorization requests.
• Follow-up: Conduct regular follow-ups with insurance companies to check the status of prior authorization requests and resolve any issues or denials.
• Appeals: Handle denials of prior authorization by reviewing the reasons for denial, coordinating with healthcare providers to gather additional information if needed, and submitting appeal requests.
• Compliance: Ensure compliance with healthcare regulations, insurance policies, and privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA).
• Record Keeping: Maintain detailed records of all prior authorization requests, communications, and outcomes. Ensure accuracy and confidentiality of patient and treatment information.

Our Ideal Candidate:

Education and Experience

• Experience within similar role involving insurance verification or prior authorization
• Computer Proficiency: Proficiency in electronic health record (EHR) systems, medical billing software, and Microsoft Office Suite.

Required Skills and Abilities

• Knowledge of Medical Terminology: Understanding of medical terminology, procedures, and coding systems (such as ICD-10 and CPT) is essential for accurately processing authorization requests.
• Communication Skills: Strong verbal and written communication skills are necessary for interacting effectively with healthcare providers, insurance companies, and patients.
• Organizational Skills: Excellent organizational and time-management skills are crucial for managing multiple authorization requests and meeting deadlines.
• Problem-Solving Skills: Ability to identify and resolve issues with prior authorization requests, including handling denials and appeals.

What We Offer:

• Competitive pay; commensurate with experience ($17-$19/an hour)
• Benefits package is available; Health, Dental and Vision insurance, in addition to, paid vacation, sick leave, and 401(k)