Specialist - Prior Authorizations

Specialist - Prior Authorizations at Cadoo Medical Specialist - Prior Authorizations at Cadoo Medical in Jersey City, New Jersey Posted in 4 days ago.

Type:

full-time

Job Description:

OverviewWe are seeking an experienced , detail-oriented and knowledgeable Medical Records and Prior Authorization Specialist to join our Internal Medicine practice. In this role, you will be responsible for managing the medical records requests and prior authorization process for medications, procedures and tests ensuring compliance with insurance requirements while maintaining high standards of patient care. The ideal candidate will possess a strong understanding of medical terminology, coding practices, managed care processes and at least 2 years of experience.

ResponsibilitiesReview and process prior authorization requests for medical procedures, tests, and medicationsProcess medical record requests in a timely manner to and from medical facilities, legal, insurance companies, etc.

Verify patient insurance coverage and eligibility to ensure appropriate approvals are obtained for the requested services.

Communicate effectively with healthcare providers, patients, and insurance companies to gather necessary information for authorization.

Communicate with patients about authorization and benefits including patient responsibility.

Will assist the front desk reception as needed- answering phones, scheduling appointments, check-in check-out patients, collecting copays, faxes, scanningUtilize medical coding systems such as ICD-10 and CT codes to ensure accurate documentation of diagnoses and procedures.

Maintain compliance with HIPAA regulations while handling sensitive patient information.

Document all interactions and decisions in the medical records accurately.

Collaborate with clinical staff to ensure timely submission of authorization requests.

Follow up on pending authorizations and resolve any issues that may arise during the process including Appeals.

Stay updated on changes in managed care policies and procedures to ensure compliance and efficient processing of requests.

RequirementsPrevious experience of at least 2 years in a medical office setting is required.

Main location is Jersey City but may need to travel to second location in Montclair.

Strong knowledge of managed care processes and insurance verification practices.

Extremely familiar with medical terminology, medical records management, and coding (CPT, ICD-10).Excellent organizational skills with attention to detail to manage multiple authorization and medical records requests effectively.

Ability to work independently as well as part of a team in a fast-paced environment.

Strong communication skills for effective interaction with healthcare providers, patients, facilities, and insurance representatives.

Proficient in using office software applications for documentation and record keeping.

If you are passionate about providing exceptional support in the healthcare field and meet the qualifications outlined above, we encourage you to apply for the Medical Records and Prior Authorization Specialist position.

This role is eligible for paid time off, Company benefits (Medical, Dental, Vision, 401k). recblid 3jpdpv0ln46fm37g1kyw3krknf3fhl