Job Overview
We are seeking a detail-oriented and proactive Medical Insurance Verification and Prior Authorization Specialist to join our healthcare team. Your primary responsibility will be to ensure all patient insurance eligibilities are verified and necessary prior authorizations are secured before appointments and procedures, minimizing billing delays and denials.
Your expertise will help streamline patient intake procedures, reduce claim denials, and uphold the highest standards of confidentiality and compliance. If you thrive in a fast-paced environment and have a passion for healthcare administration, this position offers an exciting opportunity to contribute to quality patient care and operational efficiency.
Responsibilities
- Eligibility Verification: Confirm patient insurance coverage, co-pays, deductibles, and out-of-pocket maximums prior to scheduled visits.
- Authorization Management: Submit, track, and secure prior authorizations for procedures, medications, and specialist referrals in a timely manner.
- Documentation: Accurately enter and update insurance information and authorization approvals into the Electronic Health Record (EHR) system.
- Communication: Act as the primary point of contact for insurance companies regarding disputes or missing information; communicate coverage details clearly to clinical staff and patients.
- Denial Prevention: Identify and resolve potential insurance issues or discrepancies before care is delivered to prevent claim denials.
- Maintain confidentiality: Ensure all insurance data complies with HIPAA regulations and clinical confidentiality policies to protect patient privacy.
- Maintain excellence: Stay updated on health insurance policy changes, medical terminology updates, and coding requirements to ensure compliance and accuracy.
Experience
- Experience: Minimum of 1–2 years of experience in medical insurance verification, billing, or prior authorization management.
- Knowledge: Strong understanding of medical terminology, ICD-10/CPT codes, health insurance policies, managed care processes, and medical billing procedures is essential. and managed care plans (PMO, PPO, Medicare, Medicaid). Familiarity with HIPAA regulations and clinical confidentiality policies to safeguard patient information.
- Tech-Savvy: Proficiency with EHR/EMR systems and insurance clearinghouses/portals (e.g., Availity).
- Attributes: Excellent communication skills, strong attention to detail, and the ability to multitask in a fast-paced environment.
Join us as a Medical Insurance Verification and Prior Authorization Specialist to play a crucial role in delivering seamless healthcare services while advancing your career in a dynamic environment committed to excellence!
Pay: $18.00 - $28.00 per hour
Work Location: Remote
