Medical Billing Office Prior Authorization Specialist

Join our billing team as a Prior Authorization Specialist where you can make a meaningful impact on patient care while advancing your career in the healthcare field. We offer full-time hours with fantastic benefits.

Job Summary:

The Prior Authorization Specialist will work in our fast-paced surgeon’s office to manage all aspects of prior authorizations for surgical procedures, diagnostic tests, office visits and treatments. This position ensures that insurance approvals are obtained in a timely and accurate manner, minimizing delays for patients and optimizing revenue cycle efficiency. The ideal candidate is highly organized, detail-oriented, and able to communicate effectively with patients, insurance companies, internal team members, and providers.

Essential Functions:

• Review patient records, surgical plans, and insurance coverage to determine the need for prior authorization.
• Submit accurate and complete prior authorization requests to insurance companies.
• Follow up with insurance companies to secure approvals, and appeal denials when necessary.
• Collaborate with surgeons, clinical staff, and patients to ensure all required documentation is available for submission.
• Maintain detailed and accurate records of authorization statuses in the electronic medical record (EMR) system.
• Communicate approval or denial outcomes to patients, surgeons, and office staff.
• Stay informed of insurance policies, payer guidelines, and changes to prior authorization processes.
• Assist with billing-related inquiries and claims denials related to authorization issues.
• Provide education and support to patients regarding their insurance coverage and the authorization process.

Education and/or Experience:

• A minimum of a high school diploma or equivalent is required. Associates' or Bachelor’s degree, preferred.
• At least one year of experience in a healthcare or outpatient medical office setting (physician’s office or ambulatory surgery centers) within the last five years_ is required._Surgical specialty experience strongly preferred.
• Previous billing, collection, and/or health insurance verification experience is strongly preferred.
• Must have excellent interpersonal, communication, and telephone skills.
• Bilingual in English and Spanish, preferred.

Necessary Knowledge, Skills and Abilities:

• Demonstrated computer experience, preferably with Epic EHR.
• Strong understanding of medical terminology, CPT, ICD-10 codes, and insurance processes.
• Excellent communication and interpersonal skills for interaction with patients, staff, and insurance representatives.
• High level of accuracy and attention to detail in documentation and data entry.
• Strong organizational skills with the ability to manage multiple tasks and deadlines.
• Ability to work independently as well as collaboratively within a team environment.
• Problem-solving skills and the ability to navigate complex insurance requirements.
• Familiarity with HIPAA regulations and the importance of maintaining patient confidentiality.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and other relevant software.

Physical Demands

• Prolonged periods of sitting at a desk and working on a computer.
• Occasional standing, walking, or lifting of office materials (up to 15 pounds).
• Ability to use standard office equipment, including telephones, computers, and printers.

This job description outlines the general nature and level of work performed by employees in this role. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Employees may be required to perform other duties as assigned to meet the needs of the office.

Job Type: Full-time

Pay: $18.00 - $23.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Relocation assistance
• Retirement plan
• Vision insurance

Education:

• High school or equivalent (Required)

Experience:

• Medical billing: 1 year (Required)

License/Certification:

• Medical Coding Certification (Required)

Ability to Relocate:

• Medford, OR 97504: Relocate before starting work (Required)

Work Location: In person

Salary : $18 - $23