Prior Authorization Specialist

Prior Authorization Specialist

Job Description

Job Overview: We are seeking a detail-oriented and energetic Prior Authorization Specialist to join our team. In this vital role, you will manage the authorization process for various medical services, ensuring timely approval from insurance providers. Your expertise will help streamline patient care, reduce delays, and enhance overall satisfaction by navigating complex managed care protocols with precision and professionalism.

Key Responsibilities:

1. Review and prepare prior authorization requests for medical procedures, medications, and treatments
2. Verify insurance coverage and eligibility through insurance verification processes
3. Accurately code procedures using CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems
4. Maintain comprehensive medical records and documentation in compliance with HIPAA regulations
5. Communicate effectively with healthcare providers, insurance companies, and patients to facilitate authorization approvals
6. Track and follow up on pending authorizations to ensure timely responses
7. Stay current with changes in managed care policies, coding standards, and regulatory requirements

Qualifications:

• Proven experience in managed care or medical office environments, preferably with prior authorization responsibilities
• Strong knowledge of medical terminology, medical records management, and medical coding (CPT, ICD-9, ICD-10)
• Familiarity with insurance verification processes and healthcare billing procedures
• Experience working in dental or medical offices is highly desirable
• Excellent organizational skills with attention to detail and accuracy
• Ability to navigate HIPAA regulations diligently to protect patient confidentiality
• Office experience demonstrating proficiency with electronic health records (EHR) systems or similar software

Benefits:

• Competitive salary based on experience.
• Medical, Dental, & Vision Heath Insurance
• Company Paid Life Insurance
• Affiliated with the STAR program, assist employees in paying off student loans
• Tuition Reimbursement program
• Paid Time-Off
• 6 paid Holidays off
• Opportunities for Advancement
• Yearly Merit Raises

Join our dedicated team at DeCoach Recovery and contribute to our mission of providing quality addiction treatment services while ensuring financial sustainability through effective revenue cycle management. If you have the required skills and experience, we encourage you to apply and become part of our compassionate and dynamic team.