As a Prior Authorization Specialist, you will be responsible for verifying insurance coverage, obtaining necessary authorizations, and coordinating with psychiatric physicians to ensure that patients receive the medical services or treatments they need. You will work closely with insurance companies, our psychiatrists, and patients to navigate the prior authorization process efficiently.

This is a full-time position with opportunities for career advancement for the right candidate.

Job Responsibilities:

Insurance Verification:

• Review insurance policies to understand specific requirements for prior authorizations.
• Verify patient insurance coverage and benefits to determine eligibility for services.

Prior Authorization Process:

• Initiate and complete prior authorization requests for our Interventional Services at NeuroScience & TMS Treatment Center.
• Collect and organize necessary medical documentation required for authorization approval.
• Submit authorization requests to insurance companies through appropriate channels (online portals, phone, fax, etc.).
• Follow up on submitted requests to ensure timely processing and approval.

Communication and Coordination:

• Communicate with outside healthcare providers to obtain clinical information and documentation required for prior authorization requests.
• Collaborate with physicians, nurses, and other healthcare professionals to facilitate the authorization process.
• Serve as a liaison between insurance companies, healthcare providers, and patients to resolve any issues or discrepancies related to prior authorizations.

Documentation and Record-Keeping:

• Maintain accurate records of prior authorization requests, approvals, denials, and appeals.
• Document communication with insurance companies and physicians regarding authorization status and updates.
• Ensure compliance with all relevant regulations and guidelines governing the prior authorization process.

Quality Assurance and Compliance:

• Review prior authorization requests for completeness and accuracy before submission.
• Adhere to established protocols and procedures for obtaining authorizations in accordance with industry standards and regulatory requirements.
• Stay informed about changes in insurance policies, billing codes, and healthcare regulations that may impact the prior authorization process.

Qualifications:

• Bachelor's Degree in related field
• Strong communication and interpersonal skills, with the ability to engage effectively with diverse populations
• Excellent organizational skills and attention to detail
• Ability to maintain confidentiality and adhere to ethical guidelines in handling sensitive client information
• Flexibility to adapt to changing priorities and work collaboratively in a fast-paced environment

Skills

• Knowledge of office administrator responsibilities, systems and procedures
• Proficiency in MS Office (MS Excel and MS Outlook, in particular)
• Hands on experience with office machines (e.g. scanners and printers)
• Excellent time management skills and ability to multi-task and prioritize work
• Attention to detail and problem-solving skills
• Excellent written and verbal communication skills
• Strong organizational and planning skills in a fast-paced environment
• A creative mind with an ability to suggest improvements
• College degree required

Work Remotely

• No

Job Type: Full-time

Pay: $35,360.00 - $39,000.00 per year

Benefits:

• 401(k) matching
• Paid time off

Schedule:

• 8 hour shift
• Monday to Friday
• No weekends

Education:

• Bachelor's (Required)

Experience:

• Healthcare: 1 year (Required)

Ability to Relocate:

• Nashville, TN 37216: Relocate before starting work (Required)

Work Location: In person