Prior Authorization Specialist

Prior Authorization Specialist Novo Rx Pharmacy Hackensack, NJ Job Details Part-time $20.39 - $29.46 an hour 1 day ago Benefits Flexible schedule Qualifications Collaborate with healthcare professionals Record keeping Medical documentation Insurance prior authorization Managed care Electronic health records (EHR) management Achieving HIPAA compliance Maintaining patient confidentiality Medical office experience Regulatory compliance HIPAA Mid-level

ICD-9 ICD-10

Records management Dental office experience Patient interaction Managing patient records Medical terminology Communication skills Office experience Full Job Description Job Overview We are seeking a proactive and detail-oriented Prior Authorization Specialist to join our dynamic healthcare team. In this vital role, you will be responsible for managing the authorization process for medical procedures, tests, and treatments to ensure timely approval and seamless patient care. Your expertise will help facilitate communication between healthcare providers, insurance companies, and patients, ensuring compliance with all regulatory standards including HIPAA. This position offers an exciting opportunity to contribute to efficient healthcare delivery while utilizing your knowledge of managed care, medical coding, and insurance verification. Duties Review and process prior authorization requests for medical services, procedures, and medications in accordance with insurance guidelines. Communicate effectively with healthcare providers to gather necessary documentation and clarify authorization requirements. Verify patient insurance coverage and eligibility using managed care systems to ensure accurate approvals. Maintain detailed records of authorization requests, approvals, denials, and related correspondence in compliance with HIPAA regulations. Collaborate with medical offices and insurance carriers to resolve authorization issues promptly, minimizing delays in patient care. Utilize CPT (Current Procedural Terminology), ICD-9 (International Classification of Diseases, Ninth Revision), ICD-10 (Tenth Revision), and other medical coding systems accurately for documentation purposes. Stay updated on changes in insurance policies, managed care protocols, and coding standards relevant to prior authorization processes. Requirements Proven experience in a medical office setting or healthcare environment, preferably with prior authorization responsibilities. Strong knowledge of managed care policies, insurance verification processes, and medical coding including CPT, ICD-9, ICD-10, and ICD coding standards. Familiarity with medical terminology and medical records management to accurately interpret clinical documentation. Experience working within HIPAA guidelines to ensure confidentiality and security of protected health information (PHI). Excellent communication skills to liaise effectively with healthcare providers, insurance companies, and patients. Office experience with proficiency in electronic health records (EHR) systems or similar software tools. Additional experience in dental office environments or medical billing is a plus but not required. Join us as a Prior Authorization Specialist and be part of a dedicated team committed to delivering exceptional healthcare support! Your expertise will help streamline approval processes, improve patient outcomes, and uphold the highest standards of compliance and professionalism.

Pay:

$20.39 - $29.46 per hour

Benefits:

Flexible schedule

Work Location:

In person