Prior Authorization Representative

Overview
Join our dynamic healthcare team as a Prior Authorization Representative, where your expertise will drive efficient approval processes for patient care. In this vital role, you will serve as the key liaison between healthcare providers, insurance companies, and patients to secure necessary authorizations for medical services, medications, and procedures. Your proactive approach and attention to detail will ensure timely approvals, helping patients receive the care they need without delay. This position offers an energetic environment where your skills in managed care and medical coding can truly make a difference.

Responsibilities

• Review and process prior authorization requests for medical services, medications especially for infusion center with chemotherapy and biological medications, and procedures in accordance with insurance guidelines and healthcare policies
• Verify patient insurance coverage and eligibility through insurance verification procedures
• Communicate effectively with healthcare providers to gather necessary documentation and clarify authorization requirements
• Utilize medical terminology, CPT coding, ICD-9, ICD-10, and ICD coding to accurately document requests and responses
• Maintain comprehensive medical records related to authorization requests while ensuring compliance with HIPAA regulations
• Follow up on pending authorizations to ensure timely approvals and resolve any issues that may arise during the process
• Collaborate with office staff to streamline workflows related to insurance verification, medical records management, and authorization tracking

Requirements

• Proven experience in managed care or medical office environments with a strong understanding of insurance processes
• Familiarity with HIPAA regulations to safeguard patient privacy and confidentiality
• Knowledge of CPT coding, ICD-9, ICD-10, and general ICD coding practices for accurate documentation
• Prior office experience working with medical records, medical terminology, and medical coding systems
• Strong skills in insurance verification procedures and managing prior authorization workflows
• Experience working in dental or other specialty offices is a plus but not required
• Excellent communication skills to liaise effectively with healthcare providers, insurance companies, and patients

Join us in making a meaningful impact by ensuring patients receive timely approvals for their essential healthcare needs. Your dedication to accuracy and efficiency will support our mission of delivering exceptional patient care through seamless authorization processes.

Pay: $20.00 - $25.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance

Work Location: Hybrid remote in El Centro, CA 92243

Salary : $20 - $25