Pre-Certification Specialist

Job Summary
We are seeking a detail-oriented and knowledgeable Prior Authorization Specialist to join our team. This role is essential 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 insurance verification, and medical terminology, along with the ability to navigate complex healthcare systems efficiently.

Responsibilities

• Review and process prior authorization requests for medical procedures, tests, and medications.
• Verify patient insurance coverage and eligibility for services.
• Communicate with healthcare providers, insurance companies, and patients to gather necessary information for authorization.
• Utilize basic medical coding knowledge (ICD-10) to accurately document diagnoses and procedures.
• Maintain compliance with HIPAA regulations to protect patient confidentiality.
• Keep detailed records of authorization requests and outcomes in medical records systems.
• Stay updated on changes in insurance policies and procedures affecting prior authorizations.

Experience

• Previous experience in a healthcare setting, preferably in a role related to prior authorizations or medical billing.
• Proficiency in medical terminology and understanding of coding systems (ICD-10).
• Familiarity with insurance verification processes and requirements.
• Experience working with electronic health records (EHR) systems is a plus.
• Strong attention to detail and organizational skills are essential for managing multiple requests efficiently.
• Excellent communication skills to effectively interact with patients, providers, and insurance representatives.

If you are passionate about facilitating patient care through effective authorization processes and have the necessary skills in medical coding and insurance verification, we encourage you to apply for this vital role within our organization.

Job Type: Full-time

Work Location: In person