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MR
Minneapolis Radiation Oncology, P.A.
Prior Authorization Specialist
Career Insights for Medical Claims Processor / Representative
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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.
$48,908 / year median in Minnesota
-10% projected decline
Job Description
Minneapolis Radiation Oncology has an opening for a Prior Authorization Specialist position at our Business Office in Minneapolis (near the Edina area). Hours are 7:30 am to 4:00 pm, Monday through Friday, starting full-time in our Edina Business Office. The ability to work a hybrid schedule with 1-2 days per week remotely is an option once fully trained after approximately 3 to 6 months.
Duties and Responsibilities:
- Obtain prior approval from patient's health insurance plan before moving ahead with radiation treatments or procedures to ensure health insurance claims are processed and paid correctly
- Communicate internally with clinic personnel to obtain and interpret complex radiation treatment planning information and quickly facilitate prior authorizations and appeals for pre-service denials if needed
- Complete medical necessity paperwork and submit to/follow-up with various insurance carriers
- Review and appeal rejected claims
- Spend significant time on the phone talking to insurance companies and 3rd party vendors
- Work with various business office departments and clinics to streamline processes and ensure timely accurate billing
Requirements:
MUST HAVE
previous recent experience submitting prior authorization requests to insurance carriers.- Prefer previous understanding of billing, coding, insurance carriers and/or radiation oncology.
- Excellent computer skills with Microsoft Office programs and Electronic Medical Record (EMR) software are required to be able navigate a variety of systems and websites quickly.
- Excellent written and verbal communication skills to speak with health insurance carriers, medical professionals, patients and/or business office co-workers.
- Ability to reliably multi-task, pay attention to details, follow through and problem solve are required.
- Annual Influenza (flu) vaccination is required, unless approved by MRO for a medical or religious exemption.