Prior Authorization Specialist

Job Overview We are seeking a dynamic and detail-oriented Prior Authorization Specialist to join our healthcare team! In this vital role, you will be the driving force behind securing prior authorizations for medical services, ensuring patients receive timely and appropriate care. Your expertise in managed care, medical terminology, and insurance verification will help streamline the approval process, reduce delays, and improve patient outcomes. If you thrive in a fast-paced environment and are passionate about navigating complex insurance protocols, this opportunity is perfect for you! Duties Review patient records and medical documentation to determine the necessity of services based on insurance requirements and clinical guidelines. Communicate proactively with healthcare providers to gather additional information or clarification needed for authorization requests. Submit prior authorization requests accurately via electronic portals or fax, ensuring all required documentation is complete and compliant with HIPAA regulations. Track and follow up on pending authorizations to ensure timely approvals, escalating issues as necessary. Verify insurance coverage details, including managed care plans, CPT (Current Procedural Terminology) codes, ICD (International Classification of Diseases) codes such as ICD-9 and ICD-10, and other relevant coding information. Maintain meticulous records of all authorization requests, correspondence, and approvals in medical records systems. Collaborate with billing departments to ensure accurate coding and documentation for reimbursement purposes. Qualifications Proven experience in medical office administration or healthcare setting, preferably with prior authorization responsibilities. Strong knowledge of managed care processes, insurance verification procedures, and medical coding including CPT, ICD-9, ICD-10, and ICD coding systems. Familiarity with HIPAA regulations to ensure patient privacy and data security. Excellent understanding of medical terminology and medical records management. Office experience with proficiency in electronic health record (EHR) systems or similar software platforms. Ability to communicate effectively with healthcare providers, insurance companies, and patients while maintaining professionalism. Dental office experience is a plus but not required; a background in medical or dental office environments is highly valued. Join our team to make a meaningful difference by facilitating smooth authorization processes that support quality patient care! We value energetic professionals who are eager to contribute their expertise in managed care, medical coding, and healthcare administration to enhance our service delivery every day.

Pay:

$22.00 - $24.00 per hour

Benefits:

401(k) Dental insurance Disability insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person