Prior Authorization Specialist Position Available In Delaware, Pennsylvania

Prior Authorization Specialist Main Line Health Imaging, LP Bryn Mawr, PA 19010 Overview We are seeking a detail-oriented and knowledgeable Prior Authorization Specialist to join our healthcare team. This role is crucial in ensuring that patients receive the necessary medical services and procedures by obtaining prior authorizations from insurance providers. The ideal candidate will have a strong understanding of medical coding, insurance verification, and the healthcare system, particularly in relation to HIPAA regulations.

Duties/Responsibilities:

Access assignments via work queues to review insurance information registered for accuracy and completeness. Contacts insurance carrier and/or reimbursement sources via telephone and/or electronic tools to verify eligibility and obtain all applicable benefits pertaining to services being rendered. Provides required clinical and demographic information to payer to obtain the proper authorization/pre-certification for the services being rendered. Identifies potential quality and utilization concerns and refers to Management when appropriate and will follow-up with actions as indicated. Communicate and coordinate with physicians/offices if peer to peer is needed to obtain prior authorization. Works with registrars, when needed, to resolve problems related to missing or unclear insurance authorizations. Meets on a regular basis with Management and communicates clearly the progress and status of all assigned functions and assists in projects for the department to enhance patient care and quality assurance. Exercises complete patient confidentiality in all dealings with patient information and demonstrates an awareness of patient/employee safety when carrying out daily responsibilities of their position. Participate in front office training to stay abreast of front office policy and procedures. Performs other duties as assigned.

Required Skills/Abilities:

Excellent verbal and written communication skills. Excellent interpersonal, negotiation, and conflict resolution skills. Excellent organizational skills and attention to detail. Strong knowledge of insurance protocols and providers across all service lines. Basic knowledge of medical terminology preferred. Ability to act with integrity, professionalism, and confidentiality. Proficient with Microsoft Office Suite or related software. EPIC experience strongly preferred

Education and Experience:

High Diploma or equivalent Required. 2+ years of Pre-certification experience preferred or 4 years of relevant insurance experience. Health care experience preferred.

Physical Requirements:

Prolonged periods of sitting at a desk and working on a computer. Prolonged periods of frequent standing & travel. Must be able to lift 25 pounds at times. Must be able to access and navigate each department at the organization’s facilities.

EEO Statement & Mandates:

Main Line Health Imaging, LP, is an equal opportunity employer. We believe in creating and celebrating a culture of belonging and are committed to creating an inclusive environment for all teammates. Based on current government regulations, FLU vaccine may be mandated, offering medical or religious exemptions upon request. All applicable FLU mandates will be identified and discussed during the interview process.

Job Type:

Full-time Pay:

From $60,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Disability insurance Employee assistance program Health insurance Health savings account Life insurance Paid time off Parental leave Vision insurance Ability to

Commute:

Bryn Mawr, PA 19010 (Required)

Work Location:

In person