What are the responsibilities and job description for the Prior Authorization Coordinator position at Prestige Medical Care?
Overview
The Prior Authorization Specialist plays a crucial role in the healthcare system by ensuring that patients receive the necessary medical services and treatments. This position requires a detail-oriented individual who is knowledgeable in medical terminology, coding, and managed care processes. The specialist will work closely with healthcare providers, insurance companies, and patients to facilitate the authorization process for various medical procedures and treatments.
Duties
- Review and process prior authorization requests from healthcare providers to determine eligibility for services.
- Communicate with insurance companies to obtain necessary approvals for treatments and procedures.
- Maintain accurate records of all authorization requests and decisions in compliance with HIPAA regulations.
- Utilize medical coding knowledge, including ICD-9 and ICD-10, to ensure proper documentation of diagnoses and procedures.
- Collaborate with medical office staff to gather required information for authorization requests.
- Provide guidance to healthcare providers regarding the prior authorization process and requirements.
- Stay updated on changes in managed care policies and procedures that may affect authorization processes.
- Assist in resolving any issues or denials related to prior authorizations.
Qualifications
- Strong understanding of HIPAA regulations and compliance standards.
- Familiarity with medical terminology, coding practices, including ICD-9 and ICD-10.
- Excellent communication skills, both verbal and written, to effectively interact with healthcare providers and insurance representatives.
- 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.
- Previous experience in managed care or prior authorization processes is a plus.
This role is essential for ensuring that patients receive timely access to necessary healthcare services while maintaining compliance with industry regulations. If you are passionate about supporting patient care through effective communication and administrative skills, we encourage you to apply for this rewarding position.
Job Types: Full-time, Part-time
Pay: $20.00 - $25.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Paid time off
Work Location: In person
Salary : $20 - $25
