Position Description :

The Pre-Authorization Specialist plays a crucial role in obtaining timely pre-authorization from insurance companies for medical services, reducing financial strain on patients.

They ensure surgical procedures are authorized, enabling the medical team to deliver necessary care efficiently.

Key Responsibilities :

• Pre-Authorization Process : Initiate, track, and follow up on pre-authorization requests for medical procedures, tests, surgeries, and treatments as prescribed by physicians.
• Insurance Verification : Verify patients' insurance coverage and benefits to determine pre-authorization requirements and ensure accuracy of information.
• Documentation : Maintain detailed records of pre-authorization requests, approvals, denials, and appeals, ensuring compliance with regulatory requirements and internal policies.
• Communication : Liaise with insurance companies, physicians, medical staff, and patients to provide updates on pre-authorization status, resolve issues, and address inquiries promptly and professionally.
• Billing Support : Collaborate with the billing department to ensure accurate coding and billing of pre-authorized services, and assist with resolving any billing-related issues.
• Authorization Appeals : Prepare and submit appeals for denied pre-authorization requests, providing necessary documentation and supporting information to overturn denials.
• Adherence to Policies : Adhere to all relevant policies, procedures, and guidelines related to pre-authorization processes, confidentiality, and compliance with healthcare regulations.
• Understanding insurance policies : Deep understanding of various insurance policies and their coverage for surgical procedures.

Be familiar with using coding tools like supercoder and Codify.

Qualifications :

• Education : High school diploma or equivalent required. Associate's or bachelor's degree in healthcare administration, medical billing, or related field preferred.
• Experience : Minimum of 2 years of experience in healthcare administration, medical billing, or insurance verification, with specific experience in pre-authorization processes preferred.
• Knowledge : Understanding of medical terminology, insurance plans, billing codes (CPT, ICD-10), and healthcare regulations.
• Skills : Excellent communication skills, both verbal and written, with the ability to effectively interact with diverse stakeholders.

Strong organizational skills, attention to detail, and proficiency in using electronic health records (EHR) and billing software.

• Team Player : Ability to work collaboratively in a fast-paced medical environment, prioritize tasks, and adapt to changing priorities.
• Problem-Solving : Critical thinking skills and the ability to analyze information, identify issues, and implement solutions effectively.

Benefits :

• Competitive salary
• Health, vision, and dental insurance
• Retirement plan
• Paid time off and holidays (full-time)

Peak ENT Associates is an equal opportunity employer. We welcome candidates from diverse backgrounds to apply.

Last updated : 2024-05-08