Prior Authorization Specialist

Job Summary
We are seeking a dynamic and detail-oriented Prior Authorization Specialist to join our healthcare team. In this vital role, you will be responsible for managing the prior authorization process to ensure timely approval for medical procedures, treatments, and services. Your expertise will help streamline communication between healthcare providers, insurance companies, and patients, ensuring compliance with all regulatory standards such as HIPAA. The ideal candidate will possess strong knowledge of managed care, medical coding, and medical office procedures, contributing to efficient patient care coordination and insurance verification.

Responsibilities

• Review and process prior authorization requests for medical services, procedures, and medications in accordance with insurance guidelines.
• Communicate effectively with healthcare providers to gather necessary documentation and clarify authorization requirements.
• Verify patient insurance coverage and eligibility using insurance portals and verification systems.
• Maintain accurate medical records, including documentation of authorization status, correspondence, and related medical information.
• Apply CPT (Current Procedural Terminology) codes, ICD-9/ICD-10 (International Classification of Diseases), and other relevant medical coding standards to ensure precise billing and documentation.
• Ensure compliance with HIPAA regulations by safeguarding patient information during all communication and recordkeeping activities.
• Collaborate with office staff to facilitate smooth workflow processes related to insurance approvals and patient scheduling.
• Stay updated on changes in managed care policies, coding updates, and insurance requirements to provide accurate support.

Experience

• Prior experience working in a medical office environment or dental office setting is highly preferred.
• Strong knowledge of managed care systems, insurance verification processes, and prior authorization procedures.
• Familiarity with medical terminology, medical records management, and medical coding including CPT codes and ICD classifications (ICD-9/ICD-10).
• Experience handling HIPAA compliance protocols to protect patient privacy.
• Excellent organizational skills with the ability to manage multiple requests efficiently under tight deadlines.
• Knowledge of insurance billing processes and familiarity with electronic health record (EHR) systems is a plus. Join us in making a meaningful impact by ensuring patients receive the care they need promptly! We value energetic professionals who thrive in fast-paced environments and are committed to accuracy, compliance, and exceptional service delivery.

Pay: $17.00 - $22.00 per hour

Work Location: In person

Salary : $17 - $22