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WC
Washington County Hospital and Clinic
Prior Authorization Specialist
Career Insights for Medical Claims Processor / Representative
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Based on Iowa data
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What they do
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.
$43,277 / year median in Iowa
-7% projected decline
Job Description
DUTIES/RESPONSIBILITIES
(include but are not limited to the following)- Reviews and processes all assigned prior authorization requests to completion. Diligently reviews patient health care data, diagnostic testing and treatment information for completeness for insurance requirements and prior authorization process.
- Communicates with providers, and clinical staff as needed to obtain and understand clinical documentation requirements. Provide required clinical documentation to payers via phone, faxed forms, and/or website.
- Maintains documentation of authorization approvals and denials, including authorization numbers and associated codes, dates, and other relevant data
- Communicates effectively with clinical staff, payor representatives, and providers
- Recommends process improvements for increased efficiencies
- Display and promote company values
- Regular attendance
- Other projects as needed