What are the responsibilities and job description for the Prior Authorization Specialist position at California Heart Medical Associates, Inc.?
Job Summary
The Prior Authorization Specialist plays a crucial role in the healthcare system by ensuring that patients receive the necessary medical services and treatments covered by their insurance plans. This position involves reviewing and processing prior authorization requests, verifying insurance coverage, and collaborating with healthcare providers to facilitate patient care. The ideal candidate will possess a strong understanding of medical terminology, coding practices, and insurance verification processes.
Responsibilities
- Review and process prior authorization requests for in office testing, as well as outpatient procedures.
- Verify patient insurance coverage and eligibility for services.
- Communicate with healthcare providers to obtain necessary documentation for authorization.
- Ensure compliance with HIPAA regulations while handling patient information.
- Maintain accurate medical records and documentation related to prior authorizations.
- Utilize coding knowledge (ICD-10) to support authorization requests effectively.
- Collaborate with managed care organizations to resolve authorization issues.
- Provide support and guidance to patients regarding their insurance benefits and prior authorization status.
Skills
- Proficient in medical coding and terminology, with a focus on ICD-10.
- Strong understanding of insurance verification processes and managed care principles.
- Familiarity with cardiology procedures and testing.
- Excellent communication skills for effective interaction with patients, providers, and insurance companies.
- Detail-oriented with strong organizational skills to manage multiple requests efficiently.
- Ability to work independently as well as part of a team in a fast-paced environment.
- Knowledge of HIPAA regulations to ensure patient confidentiality is maintained.
This role is essential for facilitating timely access to necessary healthcare services while ensuring compliance with insurance requirements.
Job Type: Full-time
Pay: $18.00 - $20.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Ability to Commute:
- Fresno, CA 93720 (Required)
Ability to Relocate:
- Fresno, CA 93720: Relocate before starting work (Required)
Work Location: In person
Salary : $18 - $20