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OverviewWe are seeking a highly organized and detail-oriented Medical Prior Authorization Specialist to join our outpatient clinic team.
The ideal candidate will have a strong background in healthcare administration, particularly in handling prior authorizations for medical procedures, tests, and treatments.
This role requires efficient communication skills, analytical thinking, and the ability to navigate insurance requirements to ensure timely approvals for patient care.
Responsibilities
Review and process prior authorization requests for medical procedures, tests, medications, and treatments according to insurance guidelines and clinic protocols.
Maintain accurate records of prior authorization requests, approvals, denials, and appeals. Document all communication with insurance companies and healthcare providers regarding authorization status.
Communicate with patients regarding prior authorization requirements, status updates, and any financial responsibilities associated with their care.
Provide assistance and guidance to patients in navigating insurance coverage and appeals processes.
Collaborate with healthcare providers, nurses, and administrative staff to ensure timely submission and processing of prior authorization requests.
Communicate effectively with other departments to coordinate patient care and ensure compliance with insurance requirements.
Assist in the preparation and submission of appeals for denied prior authorization requests. Gather necessary documentation and information to support the appeal process and advocate for patients' medical needs.
Stay updated on changes in insurance policies, regulations, and industry trends related to prior authorization processes.
Identify opportunities for process improvements and efficiency enhancements in prior authorization management.
Qualifications
High school diploma required, Associates degree preferred
Detail-oriented with strong organizational and time management skills
Excellent communication skills, both verbal and written, with the ability to interact professionally with patients, healthcare providers and staff, and insurance representatives
Minimum of 2 years of experience in prior authorization management in a healthcare setting, preferably in an outpatient clinic or medical office
Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment
Familiar with medical billing processes, and revenue cycle management is a plus
CMU is an AA / EO institution, providing equal opportunity to all persons, including minorities, females, veterans, and individuals with disabilities.
J-18808-Ljbffr
Last updated : 2024-04-07
Full Time
Colleges & Universities
$42k-54k (estimate)
04/09/2024
04/28/2024
cmich.edu
LANSING, MI
3,000 - 7,500
1892
ANDREA HARDEN
$200M - $500M
Colleges & Universities
At Central Michigan University, we believe every great success begins with a Fired-Up attitude. We offer a modern approach to education with innovative programs, flexible delivery modes, and a focus on career preparation. Our students graduate ready to lead in their fields. From our Mount Pleasant home and our more than 25 higher education hubs across North America, our experienced and dedicated professors bring industry experience and a student-first approach to teaching. Our more than 300 academic programs are packed with opportunity to engage and learn in the field. From day one, we provide... students access to some of the regions most state-of-the-art facilities, including our MakerBot Innovation Center, our Biological Station on Beaver Island, and the states newest College of Medicine. Through hands-on learning experiences, internships and research opportunities alongside professors who are also mentors and future colleagues our students graduate with an unmatched drive and confidence. When a problem needs solved, its a CMU Chippewa who will figure it out. Thats what we do.
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