Prior Authorization Representative

Job Summary

We are seeking a dynamic and detail-oriented Prior Authorization Representative to join our healthcare team. In this vital role, you will serve as the primary point of contact for securing insurance approvals for patient treatments and procedures. Your expertise in health insurance policies, medical coding, and managed care will ensure timely authorization processes, facilitating seamless patient care. This position offers an exciting opportunity to contribute to a compassionate healthcare environment while honing your skills in medical records management, clinical confidentiality, and insurance verification.

Duties

• Review and interpret medical documentation to determine coverage eligibility based on health insurance policies, including HIPAA compliance and clinical confidentiality policies
• Communicate with healthcare providers, insurance companies, and patients to obtain necessary prior authorizations for treatments and procedures
• Utilize CPT coding, ICD-9, ICD-10, and ICD coding systems to accurately document diagnoses and services for authorization requests
• Manage electronic health records (EHR) and electronic medical records (EMR) systems to track authorization status and update patient information efficiently
• Verify insurance coverage, benefits, and eligibility through insurance portals and managed care systems using Microsoft Office tools for documentation purposes
• Follow up on pending authorizations, ensuring timely responses from insurance carriers while maintaining detailed records of all interactions
• Ensure compliance with medical billing standards and health insurance policies during the authorization process
• Provide excellent customer service by addressing patient inquiries professionally while maintaining confidentiality

Experience

• Prior experience in a medical office or healthcare setting handling insurance prior authorization processes is highly preferred
• Strong knowledge of health insurance policies, managed care operations, and medical billing procedures
• Familiarity with CPT coding, ICD-9, ICD-10, ICD coding systems, and medical terminology essential for accurate documentation
• Proficiency in EMR/EHR management software and Microsoft Office applications required for record keeping and communication
• Understanding of HIPAA regulations to ensure patient privacy and data security at all times
• Excellent communication skills to liaise effectively with healthcare providers, insurance representatives, and patients
• Demonstrated ability to handle multiple tasks efficiently while adhering to deadlines in a fast-paced environment

Join us in making a difference by streamlining the authorization process that supports quality patient care! We are committed to fostering a supportive environment where your skills grow alongside your career.

Pay: From $16.00 per hour

Work Location: In person