What are the responsibilities and job description for the Insurance Prior Authorizations/Billing Representative position at DIGESTIVE CARE SPECIALISTS LLC?
Join our patient-centered healthcare team as a Prior Authorization/Billing Representative serving as the liaison between patients, providers and insurance companies. Daily responsibilities include verifying insurance coverage, obtaining approvals for procedures and patient account collections.
Duties/Responsibilities:
Duties/Responsibilities:
- Review, submit and track procedure authorization and pre-certification requests
- Communicate with insurance carriers via payer portals and phone to obtain approvals, authorizations, predeterminations and referrals as needed
- Follow up with insurance companies, healthcare providers and patients to resolve and delays or issues in the authorization process
- Collaborate with clinical staff, procedure schedulers and revenue cycle team to resolve authorization issues or denials
- Support escalation of cases, including coordination of peer-to-peer reviews when required
- Communicate authorization approvals or denials to the appropriate provider, facility and patient
- Maintain detailed records of all authorization activities in the electronic health record (EHR) system
- Stay updated on changes in insurance policies, authorization guidelines and referral processes to ensure compliance
- Review daily provider office schedules to confirm patient's insurance is active and required referrals are in patient's chart
- Work closely with Billing Coordinate to monitor patient accounts and provide follow up support
Required Skills/Abilities:
- Familiarity with insurance plans, coverage policies and prior authorization requirements
- Proficient use of EHRs and payer portals
- Proficiency in medical terminology, ICD-10 and CPT coding
- Strong organizational, communication and problem-solving skills
- Ability to multitask and manage priorities in a fast-paced environment
- Attention to detail and accuracy in documentation and communication
- Knowledge of HIPAA regulations and patient confidentiality standards
Education/Experience and Other:
- High school diploma or equivalent; associate degree or relevant certification in healthcare administration is a plus
- Minimum 1 - 2 years of experience in a healthcare setting with medical billing, insurance verification or authorization/referral experience
- Bilingual (Spanish) a plus
- eClinicalWorks EHR system experience a plus
This position is on-site for the first 30 days for orientation and training then remote one to two days per week.
Salary : $22 - $24