Prior Authorization-Insurance Verification Specialist

Overview:

As a Prior Authorization Specialist, you play a pivotal role in serving our clients, ensuring timely approval of medical services, procedures, and medications by collaborating with healthcare providers, insurance companies, and patients. Your primary focus is to streamline the prior authorization process, minimize treatment delays, and optimize reimbursement.


Responsibilities:
- Prior Authorization Management:
Review and assess medical service requests, ensuring adherence to prior authorization requirements.
Compile essential medical documentation to support authorization requests, including medical records, test results, and clinical notes.

- Insurance Verification:
Verify patient insurance coverage, including benefits, eligibility, and limitations.
Document insurance information accurately to facilitate billing and reimbursement.

- Documentation and Communication:
Prepare and submit prior authorization requests, following specific guidelines and requirements.
Maintain organized records of authorization requests, follow-up activities, and outcomes.
Communicate effectively with stakeholders to obtain information, clarify requirements, and provide authorization status updates.

- Policy and Compliance:
Stay current with insurance policies, guidelines, and industry regulations.
Ensure compliance with legal and regulatory requirements, including HIPAA.

- Appeals and Denials:
Assist with appeals and denials, collaborating with healthcare providers and insurance companies.
Analyze denials to identify trends and areas for improvement.

Qualifications and Skills:
- High school diploma or equivalent (some positions may require an associate's or bachelor's degree).
- Prior experience in healthcare administration, medical billing, or insurance coordination preferred.
- Strong knowledge of medical terminology, CPT codes, ICD-10 codes, and insurance procedures.
- Familiarity with US insurance plans, prior authorization requirements, and reimbursement processes.
- Excellent written and verbal communication skills.
- Detail-oriented with the ability to organize and prioritize tasks in a fast-paced environment.
- Strong analytical and problem-solving skills.
- Proficiency in using electronic health records (EHR) systems and relevant computer applications.
- Prior Authorization experience required.
- High comfort level working on Eastern or Pacific Time Zone/US Shift
- Good internet access at home at least 25 MBPS

IMPORTANT:
We'd love to get to know you better! Please send us a brief 1-minute intro video along with your application. Please share a Google Drive link for your video. Thanks!