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Cumberland Healthcare
Prior Authorization Specialist
Career Insights for Medical Claims Processor / Representative
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Based on Wisconsin 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.
$41,619 / year median in Wisconsin
-11% projected decline
Job Description
Job Summary/Duties Cumberland Healthcare is currently searching for a Prior Authorization Specialist to join our team. Their primary duty is obtaining prior authorization from insurance companies for healthcare providers. This includes verifying insurance coverage, reviewing medical records Assessing eligibility for services, communicating with insurance providers, tracking cases, updating patient insurance, managing work queues and denials, and supporting the appeal process. Experience Our ideal candidate will have the following qualifications: Prior Authorization experience required; Excellent Customer Service, communication and clerical skills; Experience working with insurance companies required; Education/experience working with Medical Terminology preferred; Knowledge of CPT and ICD/10 Coding; Advanced computer skills; Positive attitude in a fast paced environment and a team player.