Overview
We are seeking a detail-oriented and knowledgeable Prior Authorization Specialist to join our team. In this role, you will be responsible for managing the prior authorization process for medical and dental services, ensuring compliance with relevant regulations and guidelines. You will work closely with healthcare providers, insurance companies, and patients to facilitate timely approvals for necessary treatments and procedures. We offer a competitive package of wage and benefits as well as a productivity bonus of $3.00 per case for every case that we perform over 400 per month. We have been averaging about 525 cases a month and expect continued growth as patients learn that surgery centers are more cost effective.
Responsibilities
- Contact patients 7-10 days prior to surgery to let them know how much they will be responsible for paying, after verifying insurance coverage, deductible and co-pay/co-insurance amounts.
- Ensure that all authorizations are received at least 7 days prior to surgery; follow up with physician offices, if not.
- Follow up with patients after surgery to collect any balance due after insurance pays, coverage as needed.
- Research and correct and insurance or patient account issues in the computer system, coverage as needed.
- Follow up on EOB denials from insurance with insurer and/or patient to correct issues quickly.
- Review aging reports and contact insurance carriers regarding outstanding claims. Refile claims, file appeals and send additional information to insurers, as needed, to resolve claim issues.
- Answer patient calls regarding balance, payment plans or other concerns with empathy and understanding.
- Assists with front desk phone duties as needed.
- Cover Surgery Scheduler position in their absence.
- Maintain confidentiality of patient information using HIPAA guidelines.
- Other duties as assigned.
Qualifications
- Previous experience in a medical office or dental office setting is preferred.
- Strong knowledge of medical terminology, coding (ICD-10, ICD-9), and medical records management.
- Familiarity with HIPAA regulations and their application in a healthcare environment.
- Excellent organizational skills with attention to detail to manage multiple requests efficiently.
- Strong communication skills, both written and verbal, to interact effectively with healthcare professionals and patients.
- Ability to work independently as well as collaboratively within a team environment.
If you are passionate about supporting patient care through effective prior authorization processes and meet the qualifications outlined above, we encourage you to apply for this vital role in our organization.
Job Type: Full-time
Pay: $18.00 - $19.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Ability to Relocate:
- Columbia, SC 29223: Relocate before starting work (Required)
Work Location: In person
