Job Summary We are seeking a proactive and detail-oriented Prior Authorization/Referral 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, facilitate effective communication with insurance providers, and support clinical teams in delivering exceptional patient care. This position offers an exciting opportunity to contribute to a dynamic healthcare environment while maintaining compliance with industry standards and confidentiality policies. Duties Review and interpret medical documentation, including clinical notes, test results, and treatment plans to determine authorization eligibility Submit prior authorization requests accurately using Electronic Health Records (EHR) systems and insurance portals Follow up with insurance companies to track the status of pending authorizations and expedite approvals when necessary Maintain detailed records of all authorization activities, including correspondence, approvals, denials, and appeals Collaborate closely with healthcare providers, medical billing teams, and insurance representatives to resolve authorization issues promptly Ensure compliance with HIPAA regulations and clinical confidentiality policies during all interactions and data handling Stay updated on health insurance policies, managed care guidelines, and coding requirements such as CPT (Current Procedural Terminology), ICD-9/ICD-10 (International Classification of Diseases), and ICD coding standards Skills Strong knowledge of HIPAA regulations and patient privacy standards Proficiency in CPT coding, ICD-9/ICD-10 coding systems, and medical terminology Experience with Electronic Medical Records (EMR) or Electronic Health Records (EHR) management systems Familiarity with health insurance policies, managed care processes, and insurance verification procedures Excellent customer service skills with the ability to communicate effectively with providers, insurance companies, and patients Competence in Microsoft Office applications for documentation and reporting purposes Understanding of medical billing processes and medical records management Ability to work efficiently in a fast-paced office environment while maintaining attention to detail This role is ideal for individuals with prior medical office experience or healthcare administrative backgrounds who are eager to develop their expertise in insurance prior authorization. Join us to make a meaningful impact on patient care through efficient authorization management!

Pay:

$17.00 - $20.00 per hour Expected hours: 40.0 per week

Benefits:

401(k) 401(k) matching Dental insurance Disability insurance Health insurance Life insurance Paid time off Retirement plan Vision insurance

Work Location:

In person