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NORTH AMERICAN DENTAL SLEEP MANAGEMENT LLC
Insurance Specialist (Prior Authorization Coordinator)
Career Insights for Medical Claims Processor / Representative
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Based on Texas 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.
$45,636 / year median in Texas
-1% projected decline
Job Description
Description:
Are you organized, proactive, and someone who loves solving problems and keeping things moving? We're looking for a Prior Authorization Coordinator to join our growing administrative team! This role is an important part of our revenue cycle operations and plays a key role in helping patients move through the authorization process efficiently. Under the direction of the Admin Manager, you'll work closely with insurance companies and internal teams to obtain timely authorizations, verify coverage, identify opportunities for improvement, and help keep our workflows running smoothly. This is a great opportunity for someone who enjoys a fast-paced, collaborative, non-patient-facing environment, takes pride in accuracy and follow-through, and wants to make a meaningful impact on both team success and the patient experience. What You'll Do Obtain Insurance Authorizations- Secure timely prior authorizations for procedures, diagnostics, and medications to help prevent delays and denials. Verify Insurance Coverage
- Confirm eligibility, benefits, and authorization requirements before services are provided. Work with Insurance Providers
- Follow up proactively on pending requests, resolve issues, and clarify payer requirements. Track & Maintain Documentation
- Accurately document authorization requests, approvals, denials, peer-to-peers, and appeals in the practice management system. Support Patient & Clinical Communication
- Help ensure patients and clinical teams have the information they need to move forward with care. Coordinate Peer-to-Peer Reviews
- Schedule and track peer-to-peer discussions with insurance medical reviewers when needed. Provide Team Support
- Assist with Front Office and Medical Records functions as needed and help provide coverage across the administrative team. Analyze & Report
- Prepare weekly and monthly authorization reports, perform audits, and identify trends or opportunities to improve our processes.