A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
Health Information Specialist - Prior Authorization Pacific Neuropsychiatric Specialists Inc - 3.3 Irvine, CA Job Details Full-time $23 - $24 an hour 19 hours ago Benefits Health insurance Dental insurance Paid time off Vision insurance 401(k) matching Qualifications Phone communication Computer skills Client interaction via phone calls
Full Job Description Benefits:
Health insurance Paid time off Vision insurance 401(k) matching Dental insurance
Job Summary:
We are seeking a motivated and like-minded Health Information Specialist. This is a full-time, in-office position. The Health Information Specialist will manage and maintain the accuracy, security, and privacy of electronic, and paper-based, medical records, manage data quality, and ensure compliance with legal and industry standards. This person will also be responsible for helping with our prior authorizations department by discussing medications, insurance, and prior authorization documents with patients, getting prior authorization approval from insurance companies, filing appeals, and ensuring completeness and accuracy on all prior authorizations.
Key Responsibilities:
Submitting requests to insurance companies, gathering necessary documents, completing forms and following up on the status of the requests. Provide updates on the authorization, review requests for completeness and ensure all supporting documents are submitted to expedite approvals. Receive requests for prior authorizations and ensure that they are properly and closely monitored within company-set standards. Review the accuracy and completeness of the information requested and ensure that all supporting documents are present. Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is completed. Collaborate with other departments to assist in obtaining prior authorizations/appeals. Document all interactions with insurance companies within the EMR system. Proactively work on prior authorizations that are due to expire. Completes all required duties, projects, and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the leadership. Other duties as assigned
Required Skills and Qualifications:
Previous experience working in a medical/psychiatric facility is preferred. Excellent communication skills, both written and oral. Proficient telephone and computer skills. Must be able to prioritize multiple tasks at once, and deal with high stress levels in an environment of changing priorities. Must be able to interact with all levels of staffing professionally. Medical Records and Prior Authorization experience preferred, but not required.
Compensation and Benefits:
PNS offers a competitive compensation package including; medical, dental, and paid time off for full time employees. Hourly rate based on skill, experience and tenure of your profession.
