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CM
Cardiology Medical Practice
Prior Authorization Representative
Entry-Level JobVerifiedNo experience needed
Career Insights for Medical Claims Processor / Representative
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Scorecard
Based on South Carolina 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.
$45,209 / year median in South Carolina
-3% projected decline
Job Description
Overview The Prior Authorization Specialist plays a critical role by ensuring that patients receive the necessary medical services and treatments in a timely manner. This position involves reviewing and processing prior authorization requests for patients, verifying patient insurance coverage, and ensuring compliance with relevant regulations. The ideal candidate will possess strong knowledge of medical terminology. Duties Review and process prior authorization requests for patient imaging /tests. Verify patient insurance coverage and eligibility for services. Communicate with healthcare providers to obtain necessary documentation and clarify any discrepancies. Maintain accurate records of all prior authorization requests and decisions in compliance with HIPAA regulations. Assist in resolving any issues related to denied or delayed authorizations. Stay updated on changes in insurance policies, managed care guidelines, and relevant regulations affecting prior authorizations. Skills Proficient understanding of medical terminology and medical records management. Experience working in a medical office setting is preferred. Excellent organizational skills with attention to detail to ensure accurate processing of authorizations. Effective communication skills for interaction with healthcare providers and insurance representatives. Ability to work independently as well as part of a team in a fast-paced environment. Exceptional customer service.