Prior Authorization Coordinator

Job Overview
We are seeking a detail-oriented and knowledgeable Prior Authorization Specialist to join our healthcare team. This role is essential in ensuring that patients receive the necessary medical services and treatments by verifying insurance coverage and obtaining prior authorizations. The ideal candidate will possess a strong understanding of medical coding, insurance verification processes, and relevant healthcare regulations.

Duties

• 1. Manage and coordinate all aspects of the prior authorization process.
• 2. Review and verify insurance eligibility and benefits for patients.
• 3. Obtain prior authorization from insurance companies for medical procedures, tests, and medications. Documents comments and authorizations in the computer.
• 4. Communicate with healthcare providers, insurance companies, and patients to ensure timely completion of prior authorization requests.
• 5. Responsible for policies/procedures for position.
• 6. Stay up to date with changes in insurance policies and prior authorization requirements.
• 7. Identify and escalate issues or concerns related to the prior authorization process to management.
• 8. Responsible for denials relating to prior authorization including retro authorizations/reconsiderations and/or appeals.
• 9. Is able to operate all systems utilized for their job, Evident, payer websites, and RCM.
• 10. Maintains confidentiality: adheres to all HIPAA guidelines/regulations.
• 11. Provide excellent customer service to patients and healthcare providers, answering questions and providing information about the prior authorization.
• 12. Works their RCM claims and denials workque.
• 13. Processes incoming mail.
• 14. Handles phone correspondence from Insurance carriers and/or patients regarding insurance claims. Documents comments in the computer.
• 15. Codes credit card payments for posting.
• 16. Performs all other duties as assigned.

Qualifications

• High School Diploma or GED equivalent, Associates Degree Preferred
• Strong knowledge of medical records management and coding practices.
• Familiarity with insurance verification processes and prior authorization protocols.
• Excellent organizational skills with attention to detail to manage multiple requests efficiently.
• Ability to work independently as well as part of a team in a fast-paced environment.
• Proficient in using office software and electronic health record (EHR) systems.
• Strong communication skills, both verbal and written, to interact with various stakeholders effectively.

If you are passionate about facilitating patient care through effective authorization processes and meet the qualifications outlined above, we encourage you to apply for this rewarding opportunity as a Prior Authorization Coordinator.

Job Type: Full-time

Pay: $17.87 - $19.53 per hour

Expected hours: 40 per week

Benefits:

• 403(b) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Vision insurance

Work Location: In person

Salary : $18 - $20