Work Location

• Bloomfield Hills, Mi 48302

Position

The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures.

Core Responsibilities

• Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements
• Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services
• Manage correspondence with insurance companies, physicians, specialist, and patients as needed, including documenting in the EHR as appropriate
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial
• Prioritize the incoming authorizations by level of urgency
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations
• Communicate any insurance changes or trends among team
• Maintains a level of productivity according to established internal metrics
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
• Other duties as assigned.

Requirements

• High school diploma or equivalent
• Knowledge of CPT and ICD coding highly desired
• Good judgment, tact, diplomacy, and ability to problem solve
• Effective customer relation skills, ability to organize and interpret data
• Knowledge of EMR systems (Athena).

Preferred Qualifications

• Previous experience in a clinic setting preferred
• Knowledge of insurance process and medical terminology highly desired

Job Type: Full-time

Pay: $19.00 - $21.00 per hour

Benefits:

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

Weekly day range:

• Monday to Friday

Experience:

• Insurance verification: 1 year (Preferred)
• Medical billing: 1 year (Preferred)

Work Location: In person