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Advanced Medical Management LLC
Diagnostics Coordinator/Prior Authorization Specialist
Career Insights for Medical Claims Processor / Representative
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Based on Pennsylvania 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.
$42,879 / year median in Pennsylvania
-5% projected decline
Job Description
About Us Born in 1993, Excelsia Injury Care's mission is to restore quality of life through patient-centric care and support for those injured in motor vehicle or work-related accidents. With over 100 patient care centers across the Mid-Atlantic, Midwest, and Mountain West regions, our vision is to be the leading provider of injury care, setting the standard for excellence in every community we serve and expanding access to high-quality care nationwide. At Excelsia, we deliver the full continuum of outpatient care within one seamless, connected system. Our diverse team of medical specialists offers a wide range of treatment services, covering medical, orthopedics, neurology, rehabilitation, diagnostic, and surgical. We are committed to supporting patients through personalized support, detailed documentation, and outcome-oriented care coordination to make the recovery process easier. With Excelsia, patients are never far from the care they need—with the compassion they deserve. Founded on the values of respect and trustworthiness, we are committed to delivering services that adhere to the highest legal, regulatory, and ethical standards. As responsible corporate citizens, we integrate environmental, social, and governance (ESG) considerations into our business practices, ensuring that we positively impact the healthcare companies we serve, our employees, and the communities we reach. Job Summary The Diagnostic Coordinator is responsible for timely data entry, prior authorizations, and follow up of all diagnostic imaging ordered (PA, DE, NJ). They handle internal & external correspondence to help obtain correct billing information for studies to be completed and ensure reports are received. Effective communication between office, patient, attorney & MRI facility Documenting studies ordered, then following up to confirm test was done & report received Navigating EHR for claim/ health insurance info, requesting letter of protection / claim info when needed Prior authorizations through commercial health insurances Reaching out to MRI facilities directly to confirm if a patient showed to an appt, is scheduled, or for official reports to be sent Periodically reviewing yearly spreadsheet for outstanding scripts & determine reason for incompletion Assist Intake Team, Patient Care Team, and Medical Procedure Scheduling Team as needed Other duties as assigned. Additional Skills/Competencies Prior authorization experience required . Excellent verbal and written communications. Strong organization and computer literacy skills Ability to effectively communicate and train all levels of employees. Physical/Mental Requirements Sitting, standing, walking, reaching above shoulder length, working with body bent over at waist, working in kneeling position, climbing stairs, climbing ladders, working with arms extended at shoulder length, lifting maximum of 20 lbs. Why work for Excelsia Injury Care? We offer a competitive salary, a great and stable work environment as well as amazing benefit package!