Job Overview
We are seeking a detail-oriented and knowledgeable Prior Authorization Specialist to join our healthcare team. This role is crucial in ensuring that patients receive the necessary medical services and treatments by obtaining prior authorizations from insurance providers. The ideal candidate will possess a strong understanding of medical terminology, insurance verification processes, and relevant coding systems.
Duties
- Review and process requests for prior authorization for medical procedures, tests, and medications.
- Verify patient insurance coverage and eligibility through effective communication with insurance companies.
- Maintain accurate records of authorization requests and outcomes in compliance with HIPAA regulations.
- Collaborate with healthcare providers to gather necessary medical records and documentation to support authorization requests.
- Utilize ICD-9 and ICD-10 coding systems accurately in the authorization process.
- Communicate effectively with patients regarding their authorization status and any additional information required.
- Stay updated on changes in managed care policies and procedures that may affect prior authorizations.
- Assist in resolving any issues or denials related to prior authorizations.
Qualifications
- Strong knowledge of medical terminology, insurance verification processes, and managed care principles.
- Familiarity with medical coding systems, specifically ICD-9 and ICD-10.
- Previous experience in a medical office or healthcare setting is preferred.
- Excellent organizational skills with attention to detail to manage multiple authorization requests efficiently.
- Proficient in using office software and electronic health record (EHR) systems.
- Ability to communicate clearly and effectively with patients, healthcare providers, and insurance representatives.
- A commitment to maintaining patient confidentiality in accordance with HIPAA regulations.
Join our team as a Prior Authorization Specialist where your expertise will directly contribute to enhancing patient care through efficient authorization processes.
Job Type: Full-time
Pay: From $14.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Ability to Commute:
- Port Huron, MI 48060 (Required)
Work Location: In person
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