Job Summary:
We are seeking a detail-oriented and organized Account Specialist with a primary focus on Prior Authorization management for outpatient services and patient accounts. The ideal candidate will possess strong communication skills, exceptional attention to detail, and a solid understanding of medical billing procedures. In addition to managing Prior Authorizations, the Account Specialist will be responsible for performing various billing duties to ensure accurate and timely reimbursement, including provider credentialing as needed.

Responsibilities:

Prior Authorization Management:

• Review prior authorization requirements for outpatient services.
• Obtain necessary authorizations from insurance providers.
• Communicate effectively with healthcare providers and insurance companies to facilitate the authorization process.
• Maintain detailed records of authorization status and follow-up as needed.

Patient Accounts Management:

• Verify patient insurance coverage and eligibility.
• Accurately enter patient demographic and insurance information into the billing system.
• Process patient payments and reconcile accounts as necessary.
• Address patient inquiries regarding billing and insurance matters.

Billing Duties:

• Generate and submit accurate claims for outpatient services.
• Review claims for completeness and accuracy before submission.
• Follow up on unpaid or denied claims and resubmit as needed.
• Maintain knowledge of current billing regulations and coding guidelines.

Provider Credentialing:

• Assist with the credentialing process for healthcare providers.
• Ensure timely submission of credentialing applications to insurance networks and other relevant entities.
• Coordinate with providers and insurance companies to gather required documentation.
• Track credentialing status and follow up as needed to expedite the process.

Documentation and Reporting:

• Maintain organized and up-to-date documentation of all billing, authorization, and credentialing activities.
• Generate reports as needed to track authorization, billing, and credentialing metrics.
• Provide regular updates to management regarding authorization, billing, and credentialing status.

Collaboration:

• Collaborate with other members of the billing and administrative team to streamline processes and improve efficiency.
• Communicate effectively with healthcare providers and other staff members to resolve billing, authorization, and credentialing issues.

Qualifications:

• High school diploma or equivalent; Associate’s degree in healthcare administration or related field preferred.
• Minimum of 2 years of experience in medical billing, with a focus on Prior Authorization management.
• Proficiency in medical billing software and electronic health records (EHR) systems.
• Strong understanding of medical terminology, CPT codes, and insurance billing practices.
• Excellent communication skills, both verbal and written.
• Ability to work independently and as part of a team in a fast-paced environment.
• Strong attention to detail and organizational skills.
• Knowledge of HIPAA regulations and patient privacy practices.

Preferred Qualifications:

• Experience with prior authorization management.

• Experience with patient accounts.

• Certification in medical billing.
• Experience working with Medicaid, and commercial insurance providers.
• Familiarity with ICD-10,CPT, HCPCS coding guidelines.
• Experience with appeals and denials management.
• Previous experience with provider credentialing processes.

Working Conditions:

This position typically operates in a medical office or healthcare facility setting. The Account Specialist may be required to sit for extended periods and use a computer for data entry and communication. Occasional lifting of boxes or files may be necessary. This position may require occasional evening or weekend work to meet deadlines or accommodate special projects.

Note: The responsibilities and qualifications outlined above are intended to describe the general nature and level of work performed by individuals assigned to this position. They are not intended to be an exhaustive list of all responsibilities and qualifications required. Management reserves the right to modify, add, or remove duties as necessary to meet business needs.

Job Type: Full-time

Pay: $19.00 - $26.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Employee discount

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Clinic
• In-person
• Medical office
• Office
• Outpatient

Experience:

• Customer service: 1 year (Preferred)
• Microsoft Word: 1 year (Preferred)

Ability to Commute:

• Reno, NV 89501 (Required)

Ability to Relocate:

• Reno, NV 89501: Relocate before starting work (Required)

Work Location: In person