Prior Authorization Specialist

Overview
We are seeking a highly organized and detail-oriented Prior Authorization Specialist to join our team. In this role, you will be responsible for obtaining prior authorizations for medical procedures, medications, and services as required by insurance providers. Your work will involve interacting with insurance companies, and patients to ensure timely approval of services and maintain compliance with insurance guidelines and regulations. This role is essential to providing administrative support to ensure efficient operation of the office. The ideal candidate will possess strong time management skills, excellent phone etiquette, and the ability to handle multiple tasks simultaneously.

Duties

• Obtain Prior Authorizations: Initiate and manage the process of obtaining prior authorization for medical treatments, procedures, and medications, ensuring that all necessary documentation is submitted to insurance companies.
• Insurance Verification: Verify insurance coverage and benefits, and communicate with insurance carriers to clarify coverage details and requirements.
• Communication: Act as a liaison between healthcare providers, patients, and insurance companies to ensure clear and accurate communication regarding authorization requirements.
• Documentation and Record-Keeping: Maintain thorough and accurate records of authorization requests, approvals, denials, and correspondence in accordance with company and regulatory standards.
• Denial Management: Investigate and address authorization denials, including appealing denied requests and collaborating with healthcare providers to resolve issues.
• Compliance: Ensure all prior authorization requests adhere to legal, regulatory, and company policies and procedures.
• Process Improvement: Contribute to the development and improvement of prior authorization processes and workflows to enhance efficiency and reduce approval delays.
• Customer Service: Provide excellent customer service to patients and providers, addressing any questions or concerns related to prior authorization status or insurance coverage.
• Patient Scheduling: Coordinating with patients to schedule their procedures once prior authorization has been approved. Ensure that all necessary pre-appointment requirements are met, including medical clearance, authorization approval, and provider instructions.

Qualifications

• Experience: Minimum of 1-2 year(s) of experience in a healthcare setting, preferably in medical billing, coding, or insurance verification. Experience with prior authorization processes is a plus.
• Knowledge: Strong understanding of medical terminology, healthcare insurance processes, and prior authorization requirements. Familiarity with medical coding (CPT, ICD-10) and insurance payer policies is highly desirable.

Preferred Qualifications:

• Prior experience with insurance carriers or payer systems.
• Certification in medical coding, billing, or healthcare administration (e.g., CPC, CCS, or other related certifications).
• Familiarity with prior authorization platforms and tools (e.g., Availity, NaviNet, etc.).

If you are passionate about providing exceptional support and thrive in a fast-paced environment, we encourage you to apply for this opportunity.

Job Types: Full-time, Part-time

Pay: $20.00 - $25.00 per hour

Expected hours: 20 – 30 per week

Work Location: Hybrid remote in Frederick, MD 21702

Salary : $20 - $25