Prior Authorization Specialist (MA/LPN)

Job Summary The Prior Authorization Specialist plays a crucial role in the healthcare system by ensuring that patients receive the necessary medical services and treatments in a timely manner. This position involves reviewing and processing prior authorization requests from healthcare providers, verifying patient eligibility, and ensuring compliance with insurance guidelines. The ideal candidate will possess a strong understanding of medical terminology, coding, and managed care processes. Duties Review and evaluate prior authorization requests for medical procedures, tests, and medications. Communicate with healthcare providers to gather necessary documentation and clarify information regarding patient care. Verify patient eligibility and benefits through insurance portals or direct communication with insurance companies. Ensure compliance with HIPAA regulations while handling sensitive patient information. Maintain accurate records of all prior authorization requests and decisions in the electronic health record system. Collaborate with clinical staff to ensure appropriate documentation is submitted for authorization requests. Stay updated on changes in insurance policies, coding practices (ICD-10, ICD-9), and managed care guidelines. Skills Proficient in medical coding and understanding of medical records. Familiarity with ICD-10 coding standards and medical terminology. Knowledge of HIPAA regulations to ensure patient confidentiality. Strong organizational skills with attention to detail in processing requests accurately. Excellent communication skills for effective interaction with healthcare providers and insurance representatives. Experience working in an office environment, preferably within a dental office or managed care setting. Ability to work independently as well as part of a team to meet deadlines. This position is essential for facilitating patient access to necessary healthcare services while ensuring adherence to regulatory requirements.

Job Type:

Full-time Pay:

$18.00 - $22.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Disability insurance Employee discount Health insurance Paid time off Professional development assistance Retirement plan Vision insurance

Work Location:

In person