What are the responsibilities and job description for the Eligibility & Prior Authorization Specialist position at Hera Women's Health?
Job Title: Eligibility and Prior Authorization Specialist
Location: Las Vegas, NV
Job Type: Full-Time
Job Summary:
My OBGYN is seeking a detail-oriented and knowledgeable Eligibility and Prior Authorization Specialist to join our practice. The ideal candidate will be responsible for verifying patient benefits, obtaining prior authorizations for procedures and medications, and ensuring compliance with insurance guidelines.
Responsibilities:
- Verify patient insurance benefits and coverage for OBGYN services, including office visits, diagnostic tests, and surgical procedures.
- Obtain prior authorizations and pre-certifications for procedures, treatments, and medications as required by insurance providers.
- Communicate with insurance companies, patients, and healthcare providers to resolve any authorization or benefits-related issues.
- Maintain accurate records of authorizations, approvals, and denials in the electronic health record (EHR) system.
- Educate patients about their insurance benefits, coverage limitations, and out-of-pocket costs.
- Work closely with the billing department to address claim denials related to authorization issues.
- Stay up to date with insurance policies, coding changes, and payer requirements.
- Provide administrative support to the practice as needed, including scheduling and coordinating patient services.
- This position is based in our Centennial Hills office. Candidates must be able to reliably commute.
- Minimum of 1 year of experience in completing prior authorization for a medical facility; PREFERRED in an OBGYN or women’s health setting.
- Medical Assistance experience PREFERRED
- Strong understanding of insurance policies, prior authorization processes, and medical billing.
- Proficiency in electronic health records (EHR) preferably AthenaOne.
- Excellent communication and customer service skills.
- Strong attention to detail and ability to work efficiently in a fast-paced environment.
- Competitive salary based on experience
- Health, dental, and vision insurance
- 401(k) with employer matching after 1 year of service
- Paid time off (PTO) and holidays
