Job Overview
We are seeking a detail-oriented and knowledgeable Prior Authorization Specialist to join our healthcare team. In this role, you will be responsible for obtaining prior authorizations for medical procedures, medications and services ensuring compliance with insurance guidelines, and facilitating communication between healthcare providers and insurance companies. The ideal candidate will possess a strong understanding of medical coding, insurance verification processes, and HIPAA regulations.
Responsibilities
- Review and process prior authorization requests for medical procedures and medications .
- Verify patient insurance coverage and eligibility through effective communication with insurance providers.
- Utilize coding knowledge, including ICD-9 and ICD-10, to accurately complete authorization requests.
- Maintain accurate medical records and documentation in accordance with HIPAA regulations.
- Collaborate with healthcare providers to gather necessary information for authorization submissions.
- Follow up on pending authorizations to ensure timely approvals.
- Address any issues or discrepancies related to authorizations with professionalism and efficiency.
- Stay updated on changes in managed care policies and procedures that may affect authorization processes.
Requirements
- Previous experience in a medical office setting is preferred.
- Strong knowledge of medical coding (ICD-9, ICD-10) and insurance verification processes.
- Familiarity with HIPAA regulations and the importance of patient confidentiality.
- Excellent organizational skills with attention to detail to manage multiple authorization requests efficiently.
- Strong communication skills to effectively interact with patients, healthcare providers, and insurance representatives.
- Ability to work independently as well as part of a team in a fast-paced environment.
- Proficiency in using office software and electronic health record systems.
Join our dedicated team as a Prior Authorization Specialist where your expertise will contribute significantly to the quality of care we provide.
Job Type: Full-time
Pay: $15.00 - $18.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k) matching
- Health insurance
- Paid time off
Work Location: In person
