Prior Authorization Specialist/ Medical Specialists Office

Job Summary

This position has no evenings, no weekends and no holidays
The Prior Authorization Specialist plays a crucial role in the healthcare system by ensuring that patients receive the necessary medical services. This position involves reviewing and processing prior authorization requests from healthcare providers, verifying insurance coverage, and ensuring compliance with relevant regulations. The ideal candidate will have a strong understanding of medical terminology, and insurance processes, as well as excellent communication skills to liaise effectively with healthcare professionals and insurance companies.

Responsibilities

• Review and process prior authorization requests for medical procedures and services.
• Verify patient insurance coverage and benefits through managed care plans.
• Utilize ICD-10 and ICD-9 coding to accurately document diagnoses and procedures.
• Communicate with healthcare providers to obtain necessary documentation for authorization.
• Ensure compliance with HIPAA regulations while handling sensitive patient information.
• Maintain accurate medical records and documentation related to prior authorizations.
• Follow up on pending authorizations to ensure timely responses from insurance companies.
• Provide support in resolving any issues related to authorization denials or appeals.

Qualifications

• Strong knowledge of medical terminology, coding (ICD-10, ICD-9), and insurance verification processes.
• Experience in a medical office setting
• Familiarity with managed care systems and prior authorization processes.
• Excellent organizational skills with attention to detail.
• Strong communication skills, both verbal and written, to interact effectively with providers and insurance representatives.
• Ability to work independently as well as part of a team in a fast-paced environment.
• Proficient in using electronic health record (EHR) systems and other relevant software.

Candidates who meet these qualifications are encouraged to apply for the position of Prior Authorization Specialist.

If you are dependable, reliable, have an excellent work ethic, are a team player, can be at work at 6:45 AM, then please send us your resume.

Job Type: Full-time

Expected hours: 36 – 40 per week

Benefits:

• 401(k)
• Paid time off

Application Question(s):

• Advocare, LLC requires all employees to have a background check and a drug screening.

Are you willing to have these done?

Education:

• High school or equivalent (Required)

Experience:

• medical prior authorization: 1 year (Required)

Language:

• English (Required)

Work Location: In person