Prior Authorization Specialist

Overview

Join our dynamic healthcare team as a Prior Authorization Specialist, where your expertise will streamline the approval process for medical services and prescriptions. In this vital role, you will serve as the key liaison between healthcare providers, insurance companies, and patients to ensure timely and accurate authorization of medical procedures. Your proactive approach and attention to detail will help facilitate seamless patient care while maintaining compliance with healthcare regulations and policies. This position offers an exciting opportunity to make a meaningful impact in the healthcare delivery process through efficient communication and thorough documentation.

Duties

• Review and process insurance prior authorization requests for medical procedures, tests, and medications in accordance with health insurance policies
• Verify patient insurance coverage, benefits, and eligibility using electronic health records (EHR) systems and insurance portals
• Gather necessary clinical documentation from healthcare providers to support authorization requests
• Ensure compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations to protect patient confidentiality and data security
• Utilize CPT coding, ICD-9, ICD-10, and ICD coding systems accurately to support proper billing and authorization processes
• Communicate effectively with managed care organizations, insurance carriers, healthcare providers, and patients to obtain approvals or clarify requirements
• Maintain detailed records of all authorization requests, correspondence, and outcomes within electronic health records (EHR) management systems
• Stay updated on changes in health insurance policies, medical coding standards, and clinical confidentiality policies to ensure ongoing compliance

Skills

• Strong knowledge of HIPAA regulations and clinical confidentiality policies to safeguard patient information
• Proficiency in CPT coding, ICD-9, ICD-10, ICD coding systems, medical terminology, and medical records management
• Experience with electronic health records (EHR) or electronic medical records (EMR) systems for documentation and data entry
• Familiarity with health insurance policy guidelines related to managed care and insurance prior authorization processes
• Excellent customer service skills with the ability to communicate clearly and professionally across diverse stakeholders
• Ability to verify insurance coverage efficiently using Microsoft Office tools and specialized insurance portals
• Knowledge of medical billing, medical coding, insurance verification procedures, and healthcare compliance standards

This role is ideal for candidates with a background in medical office experience or office experience who are eager to contribute their healthcare knowledge in a fast-paced environment. We value proactive problem-solvers dedicated to ensuring smooth authorization workflows that enhance patient care outcomes.

Pay: $15.00 - $16.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off

Work Location: In person

Salary : $15 - $16