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WSD
Prior Authorization Specialist
Career Insights for Medical Claims Processor / Representative
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Based on Ohio data
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What they do
A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
$40,814 / year median in Ohio
-9% projected decline
Job Description
Job Overview We are seeking a detail-oriented and knowledgeable Prior Authorization Specialist to join our healthcare team. This role is essential in ensuring that patients receive the necessary medical services and treatments by managing the insurance verification and prior authorization process effectively. The ideal candidate will have a strong background in managed care, medical office operations, and a thorough understanding of medical coding and terminology. Must have prior experience with insurances and prior authorizations. Responsibilities Review and process prior authorization requests for medical services and procedures in accordance with insurance guidelines. Communicate with healthcare providers, insurance companies, and patients to gather necessary information for authorization. Verify patient insurance coverage and eligibility for services, ensuring compliance with HIPAA regulations. Utilize CPT coding and ICD-10 codes accurately to support authorization requests. Maintain organized medical records and documentation related to prior authorizations. Collaborate with clinical staff to ensure timely approvals for patient treatments. Track and report on the status of prior authorization requests, addressing any issues that may arise during the process. Skills Strong knowledge of managed care processes and insurance verification procedures. Previous experience in a medical office or dental office setting preferred. Familiarity with HIPAA regulations to ensure patient confidentiality and compliance. Proficient in CPT coding, ICD coding, and ICD-10 coding systems. Excellent understanding of medical terminology related to various specialties. Strong organizational skills with attention to detail in managing medical records. Ability to communicate effectively with healthcare professionals and patients alike. Join our team as a Prior Authorization Specialist where your expertise will contribute significantly to patient care and operational efficiency within our organization.