Pre-Authorization Representative

Job Description

Medloop a large multi-specialty medical billing company servicing many clients across the US mostly in NY/NJ is looking for a talented and highly motivated Pre-Authorization Representative for performing benefits verification and prior authorization functions with insurance carriers to ensure optimal reimbursement for high cost medications, surgeries and procedures, within an established time frame.

RESPONSIBILITIES:

Initiates prior authorization for all procedures requested by staff, providers, and or insurers.

·Serve as a liaison between patient, insurer, and practice.

·Documents all prior authorization activities and record activity.

·Collaborates with other departments, clinics, and procedures areas to assist in obtaining authorization/pre-certifications in a cross functional manner.

·Contacts plans to extend authorization dates, obtain additional visits and urgent/priority authorizations/pre-certifications, as needed.

·Notifies clinic/procedure area, Nurse Navigator, Providers and/or patients to inform them of the authorization denials. Obtains additional clinical information for denials and submits appeals to the plan for further consideration.

·Completes documentation of referrals in software to include the authorization number, number of visits, and the authorization period (dates) to ensure claims are paid in a timely manner.

·Utilizes software to process and track referrals and submit medical records to insurance carriers to expedite prior authorization processes.

·Creates patients' records and accounts and ensure that pre-authorization information is properly updated.

·Secures patients demographics and medical information and ensures that all procedures are in sync with HIPPA compliance and regulation.

·Excellent communication and organizational skills with a customer service focus.

·Must have the ability to multitask and take initiative.

·Must be able to identify inconsistencies.

REQUIRED MINIMUM QUALIFICATIONS:

·High school diploma, or equivalent

·3 years of medical billing pre-authorization experience

PREFERRED ADDITIONAL QUALIFICATIONS (not required):

·Familiar with writing appeals with successful outcomes

·Successfully acquiring GAP exceptions

·General knowledge of ICD-10, CPT-4, and HCPC coding and CCI edits

·Ability to prioritize effectively and handle shifting priorities

·Self-starter with the ability to organize work for maximum efficiency and attention to quality

At Medloop we offer great opportunities with the potential for growth. 

JOB TYPE: Full-time (In the office)

BENEFITS:

Health Insurance (Including Vision and Dental options)

401K

Great PTO Package

PAY: $23-$26 per hour