Job Overview
We are seeking a proactive and detail-oriented Medical Insurance Authorization Specialist to join our healthcare team. In this vital role, you will be responsible for managing insurance prior authorization requests, verifying coverage, and ensuring timely approval for patient services. Your expertise will help streamline the authorization process, improve patient care coordination, and maintain compliance with healthcare regulations. This position offers an exciting opportunity to contribute to a dynamic healthcare environment where your skills in medical coding, insurance policies, and customer service will make a meaningful impact.
Duties
- Review and process insurance prior authorization requests for various medical procedures and treatments in accordance with health insurance policies and managed care guidelines
- Verify patient insurance coverage using electronic health records (EHR) systems and insurance portals
- Collaborate with healthcare providers to gather necessary documentation and clinical information for authorization submissions
- Ensure compliance with HIPAA regulations and clinical confidentiality policies when handling sensitive medical records and patient data
- Utilize CPT coding, ICD-9, ICD-10, and ICD coding standards to accurately document diagnoses and procedures for authorization purposes
- Follow up with insurance companies on pending authorizations, resolving any discrepancies or denials promptly
- Maintain detailed records of all authorization activities within electronic health records (EHR) management systems and generate reports as needed
Requirements
- Proven experience in medical office administration, medical billing, or insurance verification within a healthcare setting
- Strong knowledge of health insurance policies, managed care processes, and the prior authorization workflow
- Familiarity with medical terminology, medical records management, and electronic health records (EHR) systems such as EMR/EHR platforms
- Understanding of HIPAA regulations to ensure patient privacy and data security at all times
- Ability to interpret CPT coding, ICD-9, ICD-10 codes, and perform accurate medical coding tasks
- Excellent customer service skills with the ability to communicate effectively with providers, insurance representatives, and patients
- Attention to detail and organizational skills to manage multiple cases efficiently in a fast-paced environment
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
