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Prior Authorization Specialist
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Ocala Lung & Critical Care Associates, Inc.
Ocala, FL (In Person)
Full-Time
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Job Description
Job Summary We are seeking a dedicated and detail-oriented Prior Authorization Specialist to join our healthcare team. The ideal candidate will possess a strong understanding of managed care processes, medical office procedures, and insurance protocols. As a Prior Authorization Specialist, you will be responsible for obtaining necessary approvals from insurance providers to ensure timely and efficient patient care. Your role will be vital in streamlining authorization workflows, verifying insurance coverage, and maintaining compliance with healthcare regulations such as HIPAA. Responsibilities Review patient records, medical documentation, and clinical information to prepare accurate prior authorization requests. Communicate effectively with healthcare providers, insurance companies, and patients to gather necessary information and follow up on authorization statuses. Ensure compliance with HIPAA regulations by handling protected health information securely and confidentially. Utilize CPT coding, ICD-9, ICD-10, and ICD coding systems to accurately document diagnoses and procedures for authorization submissions. Verify insurance coverage details through insurance verification processes prior to submitting authorization requests. Maintain detailed records of all authorization activities, including approvals, denials, and appeals. Collaborate with medical office staff to facilitate smooth workflows related to prior authorizations and medical records management. Stay updated on managed care policies, insurance guidelines, and changes in healthcare regulations affecting authorization procedures. Experience Prior experience working in a medical office environment is highly preferred, particularly with office experience involving medical records and documentation. Knowledge of managed care systems and insurance verification processes is essential for success in this role. Familiarity with medical terminology, CPT coding, ICD-9, ICD-10 coding standards, and medical coding practices is required. Experience handling HIPAA compliance protocols to protect patient privacy is necessary. Previous roles involving medical office administration or insurance authorization will be considered advantageous. Strong organizational skills with the ability to manage multiple cases efficiently in a fast-paced setting are crucial. Join our team as a Prior Authorization Specialist to contribute significantly to patient care coordination while ensuring compliance with healthcare standards through meticulous documentation and effective communication.