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HV
High Valley Dermatology
Part-Time Prior Authorization Specialist
Career Insights for Medical Claims Processor / Representative
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Based on Idaho 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.
$46,155 / year median in Idaho
+1% projected growth
Job Description
Job Summary We are seeking a dedicated and detail-oriented Part-Time Prior Authorization Specialist to join our healthcare team. In this vital role, you will be responsible for managing insurance prior authorization requests, ensuring timely approval for patient treatments and procedures. Your expertise will help streamline the authorization process, improve patient care coordination, and maintain compliance with healthcare regulations. This position offers an engaging opportunity to contribute to a dynamic healthcare environment while developing your skills in medical billing, coding, and insurance verification. Responsibilities Review and process insurance prior authorization requests accurately and efficiently across various managed care plans. Collaborate with healthcare providers to gather necessary clinical documentation and ensure completeness of authorization submissions. Verify patient insurance coverage, including health insurance policy details, using electronic health records (EHR) systems and other tools. Maintain detailed records of all authorization requests, approvals, denials, and related communications in compliance with HIPAA and clinical confidentiality policies. Communicate effectively with insurance companies, providers, and patients to follow up on pending authorizations or resolve issues promptly. Stay updated on changes in health insurance policies, medical billing practices, and regulatory requirements to ensure ongoing compliance. Experience Prior experience working in a medical office setting or healthcare environment is preferred. Knowledge of health insurance policies, managed care processes, and insurance verification procedures is essential. Strong understanding of medical terminology, CPT coding, ICD coding (ICD-9/ICD-10), and medical billing practices. Demonstrated ability to handle sensitive information in accordance with HIPAA regulations and maintain strict confidentiality. Join us in making a meaningful difference by ensuring our patients receive the care they need through efficient prior authorization processes!