What are the responsibilities and job description for the Prior Authorization Specialist position at Richardson Physician Services?
Job Overview
We are seeking a dedicated 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 of procedures and treatments in accordance with insurance policies and healthcare regulations. Your proactive approach will help streamline patient care, reduce delays, and enhance overall patient satisfaction. This position offers an exciting opportunity to work in a fast-paced environment where your expertise in managed care, medical terminology, and insurance verification will make a meaningful impact.
Responsibilities
- Review and process prior authorization requests for procedures, ensuring all necessary documentation is complete and accurate.
- Communicate effectively with healthcare teams, providers, insurance companies, and patients to obtain necessary approvals promptly.
- Verify insurance coverage, benefits, and eligibility using managed care systems and insurance portals.
- Maintain thorough records of authorization requests, approvals, denials, and related correspondence in compliance with HIPAA regulations.
- Utilize CPT coding, ICD-9, ICD-10, and ICD coding to accurately document diagnoses and procedures for insurance submissions.
- Collaborate with medical office staff to gather required medical records, supporting documentation, and clinical information needed for authorization decisions.
- Stay current on evolving managed care policies, insurance guidelines, and healthcare regulations to ensure compliance.
Experience
- Prior experience working in a medical office setting is required.
- Strong knowledge of managed care processes, insurance verification procedures, and medical billing practices.
- Familiarity with HIPAA regulations to ensure patient confidentiality and data security.
- Proficiency in medical terminology, medical records management, and medical coding (CPT, ICD-9/10).
- Experience with office software applications and electronic health record (EHR) systems.
- Excellent communication skills to liaise effectively with providers, insurers, and patients.
- Previous experience handling prior authorization requests in a fast-paced healthcare environment is a plus. Join us as a Prior Authorization Specialist to be a key player in delivering seamless healthcare experiences! Your expertise will help bridge the gap between providers and insurers while ensuring patients receive the care they need without unnecessary delays. We value energetic professionals who are committed to accuracy, compliance, and compassionate service—ready to make a difference every day!
Job Type: Full-time
Pay: $18.00 - $20.00 per hour
Benefits:
- 401(k)
- Employee discount
- Flexible schedule
- Paid time off
Work Location: In person
Salary : $18 - $20