Prior Authorization Clerk

Job Overview
We are seeking a dedicated and detail-oriented Prior Authorization Clerk to join our healthcare team. In this role, you will be responsible for obtaining prior authorizations for medical procedures and services, ensuring compliance with insurance requirements, and facilitating effective communication between healthcare providers and insurance companies. The ideal candidate will possess a strong understanding of medical terminology, coding, and the prior authorization process.

Responsibilities

• Review and process requests for prior authorizations for various medical services and procedures.
• Verify patient insurance coverage and eligibility to ensure compliance with policy requirements.
• Communicate effectively with healthcare providers, patients, and insurance representatives to gather necessary information.
• Maintain accurate records of authorization requests and outcomes in accordance with HIPAA regulations.
• Utilize knowledge of medical coding (ICD-9) to ensure proper documentation and justification for services requested.
• Stay updated on changes in insurance policies, procedures, and regulations affecting prior authorizations.

Experience

• Previous experience in a medical office or dental office setting is preferred.
• Familiarity with medical records management and insurance verification processes is essential.
• Knowledge of medical terminology and coding practices is highly desirable.
• Strong attention to detail and organizational skills are critical for success in this role.
• Ability to work independently as well as part of a team in a fast-paced environment.
• Collect information over phone from patients and family and relay message to provider
• Evaluates requests for prior authorizations for various medical procedures and treatments
• Obtain pre-authorizations from insurance companies
• Perform clinical reviews of authorization requests using appropriate criteria
• Ability to multitask between computer and multi-line phone requests
• Enter and maintain clinical information in multiple health management systems
• Access the medical necessity and appropriateness of requested treatments based on patient information and clinical guidelines
• Provide clear and concise documentation to support authorization decisions, including rationales and evidence
• Communicate with insurance providers and healthcare providers to gather information and address questions or concerns related to authorization requests
• Coordinate with other healthcare professionals and departments to ensure timely and accurate authorizations processes
• Stay current with changes in clinical guidelines, insurance regulations, and healthcare policies
• Collaborate with other healthcare professionals to ensure the provision of quality and cost-effective patient care
• Any other duties or tasks assigned by the Physician Practice Director or provider
• Adheres to and practices the standards of performance outlines in the Standards of Performance handbook
• Performs within the prescribed limits of the hospital’s/department’s Ethics and Compliance program. Is responsible to detect, observe, and report compliance variances to their immediate supervisor, or, upward through the chain of command, the Compliance Office or hospital hotline.

If you are passionate about supporting patient care through efficient authorization processes and have the requisite skills, we encourage you to apply for this vital role within our organization.

Job Type: Full-time

Pay: $15.20 - $19.76 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $15 - $20