Insurance Prior Authorizations/Billing Representative

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Paid time off Profit sharing Join our patient-centered healthcare team as a Prior Authorization/Billing Representative serving as the liaison between patients, providers and insurance companies. Daily responsibilities include verifying insurance coverage, obtaining approvals for procedures and patient account collections.

Duties/Responsibilities:

Review, submit and track procedure authorization and pre-certification requests Communicate with insurance carriers via payer portals and phone to obtain approvals, authorizations, predeterminations and referrals as needed Follow up with insurance companies, healthcare providers and patients to resolve and delays or issues in the authorization process Collaborate with clinical staff, procedure schedulers and revenue cycle team to resolve authorization issues or denials Support escalation of cases, including coordination of peer-to-peer reviews when required Communicate authorization approvals or denials to the appropriate provider, facility and patient Maintain detailed records of all authorization activities in the electronic health record (EHR) system Stay updated on changes in insurance policies, authorization guidelines and referral processes to ensure compliance Review daily provider office schedules to confirm patient's insurance is active and required referrals are in patient's chart Work closely with Billing Coordinate to monitor patient accounts and provide follow up support

Required Skills/Abilities:

Familiarity with insurance plans, coverage policies and prior authorization requirements Proficient use of EHRs and payer portals Proficiency in medical terminology, ICD-10 and CPT coding Strong organizational, communication and problem-solving skills Ability to multitask and manage priorities in a fast-paced environment Attention to detail and accuracy in documentation and communication Knowledge of HIPAA regulations and patient confidentiality standards

Education/Experience and Other:

High school diploma or equivalent; associate degree or relevant certification in healthcare administration is a plus Minimum 1 - 2 years of experience in a healthcare setting with medical billing, insurance verification or authorization/referral experience Bilingual (Spanish) a plus eClinicalWorks EHR system experience a plus This position is on-site for the first 30 days for orientation and training then remote one to two days per week. Flexible work from home options available.