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IH
In His Image Internal Medicine and Sleep Medicine
Prior Authorization Specialist
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
Prior Authorization Specialist In His Image Internal Medicine and Sleep Medicine North Richland Hills, TX Job Details Full-time $16 - $20 an hour 7 hours ago Benefits 401(k) Paid time off Qualifications Collaborate with healthcare professionals Electronic health records (EHR) management HIPAA Attention to detail Documentation review Full Job Description Job Overview We are seeking a proactive and detail-oriented Prior Authorization Specialist to join our healthcare team. In this vital role, you will be responsible for managing insurance prior authorization requests, ensuring timely approval for patient treatments and procedures. Your expertise will help streamline the approval process, facilitate effective communication with healthcare providers and insurance companies, and uphold the highest standards of confidentiality and compliance. This position offers an exciting opportunity to contribute to patient care coordination while working in a fast-paced, supportive environment. Duties Review and process insurance prior authorization requests accurately using medical records, clinical documentation, and insurance guidelines Collaborate with healthcare providers to gather necessary clinical information and documentation for authorization submissions Verify patient insurance coverage, benefits, and eligibility using electronic health records (EHR) systems and insurance portals Utilize medical coding skills, including CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems, to support authorization requests Maintain compliance with HIPAA regulations and clinical confidentiality policies during all interactions and record handling Track and follow up on pending authorizations to ensure timely approvals or denials, escalating issues as needed Communicate clearly with patients, providers, and insurance representatives to resolve authorization issues efficiently