What are the responsibilities and job description for the Prior Authorization Specialist position at Coastal Eye Clinic, PA?
Overview
We are seeking a dedicated and detail-oriented Prior Authorization representative to join our healthcare team. The ideal candidate will possess a strong understanding of managed care processes and insurance protocols. This role is pivotal in ensuring timely approval of medical services. Applicant should demonstrate excellent communication skills and experience navigating insurance verification processes.
Duties
- Process prior authorization requests for various medical procedures, treatments, and services
- Collaborate with healthcare providers to gather necessary documentation and ensure completeness of authorization submissions.
- Verify patient insurance coverage, benefits, and eligibility to facilitate smooth approval workflows.
- Maintain accurate records of authorization status, correspondence, and related medical documentation
- Utilize knowledge of CPT coding and ICD-10 ICD coding systems to accurately document diagnoses and procedures for authorization purposes.
- Communicate effectively with insurance companies, providers, and patients to expedite approval processes and resolve any discrepancies or denials
- Assist with medical records documentation related to prior authorizations.
Experience
- Prior experience working within managed care organizations or insurance companies is preferred.
- Medical office experience required
- Knowledge of HIPAA regulations to ensure confidentiality and secure handling of protected health information.
- Familiarity with medical terminology and medical coding (CPT, ICD-9, ICD-10)
- Experience conducting insurance verification processes is advantageous.
- Strong organizational skills with the ability to manage multiple requests efficiently in a fast-paced environment.
- Excellent communication skills for liaising effectively between providers, insurers, and patients to facilitate timely approvals.
Benefits:
- 401(k)
- 401(k) matching
- Disability insurance
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
Work Location: In person