Prior Authorization Specialist/Biller

Overview
Join our healthcare team as a Medical Prior Authorization Specialist/Biller. In this role, you'll manage prior authorization requests, ensure accurate billing, and facilitate communication between providers, insurance companies, and patients. Your attention to detail will help reduce delays in treatment approvals and billing cycles, contributing to an efficient healthcare environment. This position is a great opportunity to apply your medical office experience and coding knowledge in a fast-paced setting.

Responsibilities

• Review and prepare prior authorization requests for medical procedures, treatments, and medications, ensuring all documentation is complete and accurate.
• Communicate with insurance companies to obtain approvals, follow up on requests, and resolve issues during the authorization process.
• Verify patient insurance coverage and benefits to facilitate seamless billing procedures.
• Utilize CPT, ICD-9, and ICD-10 coding systems for accurate billing and documentation.
• Maintain detailed medical records related to authorization requests while adhering to HIPAA regulations.
• Collaborate with medical staff to gather clinical information for submissions and ensure compliance with managed care policies.
• Process medical bills by reviewing claims for accuracy, submitting them, and following up on unpaid or denied claims.

Skills

• Strong knowledge of managed care processes and insurance protocols to navigate complex authorization requirements effectively.
• Proven experience in a medical office setting with familiarity in medical terminology, medical records management, and office procedures.
• Expertise in HIPAA compliance to protect patient confidentiality at all times during documentation and communication.
• Proficiency in CPT coding, ICD-9/ICD-10 coding systems, and ICD coding standards is essential for accurate billing practices.
• Experience with insurance verification procedures to confirm coverage details before submitting authorization or claims.
• Background in medical billing with a focus on managing denials, appeals, and reimbursement processes efficiently.

Pay: From $20.00 per hour

Benefits:

• 401(k)
• Health insurance
• Paid time off

Work Location: In person

Salary : $20