What are the responsibilities and job description for the Prior Authorization, Referral Specialist position at Miles River Primary Care?
Overview
We are seeking a dedicated and detail-oriented Prior Authorization Specialist to join our healthcare team. This role is crucial in ensuring that patients receive the necessary medical services and treatments by managing the prior authorization process efficiently. The ideal candidate will have a strong understanding of medical terminology, coding, and insurance verification, along with a commitment to maintaining compliance with HIPAA regulations.
Duties
- Review and process prior authorization requests for medical services and procedures.
- Verify patient insurance coverage and eligibility for requested services.
- Communicate with healthcare providers, insurance companies, and patients to gather necessary information.
- Utilize ICD-10 and ICD-9 coding to ensure accurate documentation of medical records.
- Maintain organized records of all authorization requests and decisions in compliance with HIPAA guidelines.
- Collaborate with medical office staff to streamline the authorization process and resolve any issues that arise.
- Stay updated on changes in insurance policies, coding practices, and regulations affecting prior authorizations.
Qualifications
- Experience in a medical office setting is preferred, with a strong understanding of medical terminology.
- Proficiency in ICD-10 coding; knowledge of ICD-9 is a plus.
- Familiarity with insurance verification processes and requirements.
- Previous experience in medical records management or medical coding is advantageous.
- Excellent organizational skills with attention to detail.
- Strong communication skills, both written and verbal, to effectively interact with patients, providers, and insurers.
- Ability to work independently as well as part of a team in a fast-paced environment.
If you are passionate about helping patients navigate their healthcare needs while ensuring compliance with industry standards, we encourage you to apply for this vital role within our organization.
Job Type: Full-time
Pay: $17.00 - $20.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Ability to Commute:
- Easton, MD 21601 (Required)
Ability to Relocate:
- Easton, MD 21601: Relocate before starting work (Preferred)
Work Location: In person
Salary : $17 - $20
