Prior Authorization Specialist (PROCEDURES & SURGERIES)

Overview

We are seeking a highly motivated and detail-oriented Prior Authorization Specialist to join our healthcare team. In this vital role, you will serve as the key point of contact for obtaining insurance prior authorizations FOR PROCEDURES AND SURGERIES, ensuring that patients receive timely approval for necessary medical procedures and treatments. Your expertise will help streamline the authorization process, improve patient care, and maintain compliance with healthcare regulations. This position offers an exciting opportunity to contribute to a dynamic healthcare environment where accuracy, efficiency, and excellent customer service are paramount.

Responsibilities

• Review medical documentation and verify insurance coverage to initiate prior authorization requests
• Collaborate with healthcare providers to gather necessary clinical information and supporting documentation
• Utilize electronic health records (EHR) systems and insurance portals to submit authorization requests accurately and promptly
• Follow up with insurance companies to track approval status and resolve any issues or delays in the process
• Maintain detailed records of all authorization activities, including correspondence, approvals, denials, and appeals
• Ensure compliance with HIPAA regulations and clinical confidentiality policies when handling sensitive patient information
• Communicate effectively with patients, providers, and insurance representatives to clarify requirements and provide updates on authorization status

Experience

• Prior experience working in a medical office or healthcare setting, preferably with insurance prior authorization responsibilities
• Strong knowledge of health insurance policies, managed care processes, and insurance verification procedures
• Familiarity with medical coding systems such as CPT (Current Procedural Terminology), ICD-9, ICD-10 (International Classification of Diseases), and ICD coding standards
• Proficiency in Microsoft Office applications (Word, Excel) and electronic health records (EHR) or electronic medical records (EMR) management systems
• Understanding of medical terminology, medical records management, and clinical confidentiality policies
• Excellent customer service skills with the ability to communicate clearly and professionally across diverse audiences
• Knowledge of healthcare compliance standards including HIPAA regulations related to patient privacy and data security

Join us in making a difference by ensuring seamless access to essential healthcare services through efficient prior authorization processes. We value energetic professionals who thrive in fast-paced environments and are committed to delivering exceptional support to our patients and providers.

Pay: From $17.00 per hour

Benefits:

• Employee discount
• Health insurance
• Paid time off
• Professional development assistance
• Tuition reimbursement

Experience:

• Surgical prior Auths: 1 year (Required)

Language:

• Spanish (Preferred)

Work Location: In person