Prior Authorization Specialist

Join our dynamic healthcare team as a Prior Authorization Specialist, where your expertise will drive efficient approval processes and ensure seamless patient care. In this vital role, you will serve as the key liaison between healthcare providers, insurance companies, and patients, managing prior authorization requests with precision and professionalism. Your proactive approach will help streamline workflows, reduce delays, and support our commitment to delivering exceptional healthcare experiences. If you thrive in a fast-paced environment and are passionate about navigating complex insurance protocols, this is the opportunity for you to make a meaningful impact every day.

• Review and interpret medical documentation to determine the necessity of prior authorization requests for various treatments, procedures, or medications.
• Submit detailed authorization requests to insurance carriers via electronic portals or fax, ensuring all required information is accurate and complete.
• Follow up regularly with insurance companies to track the status of pending authorizations and expedite approvals when possible.
• Communicate proactively with healthcare providers to gather additional documentation or clarification needed for approval processes.
• Maintain meticulous records of all authorization requests, correspondence, and outcomes in accordance with HIPAA regulations and organizational policies.
• Verify patient insurance coverage and eligibility prior to submitting authorization requests to ensure smooth processing.
• Collaborate with medical office staff to update patient records with authorization statuses and relevant notes.
• Stay current on managed care policies, CPT (Current Procedural Terminology) codes, ICD (International Classification of Diseases) codes including ICD-9 and ICD-10, and other coding standards necessary for accurate submissions.
• Assist in training new team members on insurance protocols, medical terminology, and documentation requirements.
• Ensure compliance with all HIPAA guidelines to protect patient confidentiality at all times.

• Strong knowledge of managed care processes and insurance verification procedures.
• Experience working in a medical or dental office environment with familiarity in medical records management.
• Proficiency in medical terminology, including CPT coding, ICD coding (ICD-9 and ICD-10), and medical coding practices.
• Excellent understanding of HIPAA regulations related to patient privacy and data security.
• Ability to navigate electronic health record systems and insurance portals efficiently.
• Exceptional attention to detail for reviewing documentation and completing accurate submissions.
• Effective communication skills for liaising with healthcare providers, insurance representatives, and patients.
• Organizational skills to manage multiple requests simultaneously while meeting deadlines.
• Previous experience in office settings involving medical records or medical office administration is highly desirable.
• Knowledge of dental office procedures is a plus but not required. This role offers an exciting opportunity to be at the forefront of healthcare administration—empowering providers through efficient authorization workflows while ensuring compliance with industry standards. If you’re motivated by precision, enjoy problem-solving within complex systems, and want to contribute meaningfully to patient care coordination, we invite you to join our dedicated team as a Prior Authorization Specialist!

Job Type: Full-time

Pay: $22.00 - $25.00 per hour

Benefits:

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

Work Location: In person

Salary : $22 - $25