Medical Receptionist and Prior Authorization Specialist

Overview We are seeking a detail-oriented and organized Receptionist and Prior Authorization Specialist to join our healthcare team. The ideal candidate will play a critical role in ensuring that patients receive the necessary medical services by managing the prior authorization process effectively. This position requires strong knowledge of medical terminology, coding systems, and experience with electronic health record (EHR) systems. The Prior Authorization Specialist will work closely with healthcare providers, insurance companies, and patients to facilitate timely approvals for medical procedures and treatments.

Receptionist Duties:

Greeting patients warmly and checking them in/out. Answering multi-line phones and managing inquiries. Scheduling and confirming appointments. Verifying patient demographics and insurance information. Collecting co-pays and balances. Maintaining a clean and welcoming reception area.

Prior Authorization Duties:

Obtaining insurance authorizations for procedures, medications, and treatments. Submitting authorization requests and required medical documentation. Following up on pending authorizations and addressing payer inquiries. Appealing denied authorizations as needed. Remaining current on insurance carrier requirements.

Qualifications:

High school diploma or GED required. 1-2 years of experience as a medical receptionist or in a similar medical office role. Strong knowledge of insurance plans and prior authorization processes. Familiarity with Electronic Medical Records (EMR) systems (mention specific systems if preferred, like eClinicalWorks, Athena, Epic). Excellent communication and customer service skills. Ability to multitask and prioritize in a busy environment. Responsibilities Review and process prior authorization requests for medical services and procedures. Communicate with healthcare providers to obtain necessary documentation for authorization. Verify patient insurance coverage and eligibility for services. Utilize EHR systems to manage patient records and authorization requests. Ensure compliance with HIPAA regulations while handling sensitive patient information. Maintain accurate documentation of all interactions and authorization outcomes. Collaborate with clinical staff to develop care plans that meet insurance requirements. Conduct follow-ups on pending authorizations and resolve any issues that arise during the process. Provide excellent patient service by addressing inquiries related to authorizations and insurance coverage. Assist in training new staff on prior authorization processes and best practices. Requirements Strong understanding of medical terminology, CPT coding, ICD-9, and ICD-10 coding systems. Experience with medical billing, collections, and insurance verification processes. Familiarity with EHR systems. Previous experience in a medical office setting or clinic environment is preferred. Bilingual skills are a plus to enhance patient communication. Proficient computer skills including Microsoft Office Suite and typing abilities (10 key typing is advantageous). Excellent organizational skills with attention to detail in documentation review. Strong customer service skills with effective phone etiquette for multi-line phone systems. Ability to work collaboratively within a team while managing individual responsibilities effectively. Previous experience in clerical tasks related to medical records management or front desk operations is beneficial. Join our dedicated team as a Prior Authorization Specialist where you can make a meaningful impact on patient care through your expertise in managing authorizations efficiently.

Job Type:

Full-time Pay:

$20.00 - $22.00 per hour

Benefits:

401(k) Dental insurance Free parking Health insurance Paid time off Retirement plan Vision insurance

Experience:

pre-authorization : 1 year (Required) Ability to

Commute:

Toms River, NJ 08753 (Required)

Work Location:

In person