OverviewWe are seeking a detail-oriented and knowledgeable Prior Authorization Specialist to join our healthcare team. In this role, you will be responsible for managing the prior authorization process for medical services and procedures, ensuring compliance with insurance requirements, and facilitating effective communication between healthcare providers and insurance companies. Your expertise in medical terminology, coding, and insurance verification will be essential in supporting patient care and optimizing the authorization process.
Responsibilities
Review and process prior authorization requests for medical services, procedures, and medications.
Verify patient insurance coverage and eligibility through thorough research and communication with insurance providers.
Collaborate with healthcare providers to obtain necessary documentation to support authorization requests.
Maintain accurate records of all prior authorization activities in compliance with HIPAA regulations.
Utilize knowledge of medical terminology and coding to ensure proper documentation is submitted for approvals.
Follow up on pending authorizations and communicate outcomes to patients and providers promptly.
Stay updated on changes in managed care policies and procedures that may affect authorization processes.
Assist in training new staff members on prior authorization protocols as needed.
Requirements
Proven experience in a medical office or healthcare setting, preferably with a focus on prior authorizations or insurance verification.
Strong knowledge of medical terminology, coding (CPT/ICD), and HIPAA regulations.
Familiarity with managed care systems and processes is highly desirable.
Excellent organizational skills with attention to detail to manage multiple requests efficiently.
Strong communication skills, both written and verbal, to interact effectively with patients, providers, and insurance representatives.
Ability to work independently as well as part of a team in a fast-paced environment.
Proficiency in using electronic medical records (EMR) systems and office software applications.
If you are passionate about supporting patient care through effective authorization processes and possess the required skills, we encourage you to apply for this important role within our organization.
Job Type: Full-time
Pay: $21.00 – $22.50 per hour
Expected hours: 40 per week
Benefits:
401(k)
401(k) matching
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance
Work Location: Remote
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