What are the responsibilities and job description for the Prior Authorization Specialist position at Pioneer Heart Institute?
Job Summary
We are seeking a proactive and detail-oriented Prior Authorization Specialist to join our dynamic healthcare team. In this vital role, you will be responsible for managing the authorization process for medical services, ensuring timely approval from insurance providers to facilitate seamless patient care. Your expertise in managed care, medical terminology, and insurance verification will drive efficiency and accuracy in processing prior authorizations. This position offers an exciting opportunity to contribute to a collaborative environment dedicated to delivering exceptional healthcare support.
Duties
- Review and evaluate requests for prior authorization of medical procedures, treatments, and medications based on clinical guidelines and insurance policies
- Communicate effectively with healthcare providers, insurance companies, and patients to gather necessary documentation and clarify authorization requirements
- Verify patient insurance coverage, including benefits related to managed care plans, and ensure compliance with HIPAA regulations for patient privacy and data security
- Utilize CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems accurately to support authorization requests
- Maintain detailed records of all authorization activities, including documentation of approvals, denials, and appeals processes
- Collaborate with medical office staff to ensure all necessary medical records and supporting documentation are complete and accurate
- Stay updated on changes in insurance policies, coding standards, and healthcare regulations affecting prior authorization procedures
Qualifications
- Proven experience in managed care environments or medical office settings with a strong understanding of insurance verification processes
- Knowledge of HIPAA regulations to ensure confidentiality and secure handling of medical records and patient information
- Familiarity with CPT coding, ICD-9/ICD-10 coding systems, and medical terminology essential for accurate documentation
- Prior experience with medical coding and medical records management preferred
- Excellent communication skills for liaising with healthcare providers, insurance companies, and patients effectively
- Office experience in a healthcare setting is highly desirable, including familiarity with electronic health records (EHR) systems
Join us as a Prior Authorization Specialist to play a crucial role in streamlining healthcare services while supporting our mission to deliver compassionate and efficient patient care. Your expertise will help ensure that patients receive the treatments they need without delay!
Pay: $22.00 - $28.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Disability insurance
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Work Location: Remote
Salary : $22 - $28