Prior Authorization Specialist

Job Description

Job DescriptionDescription:

The Prior Authorization Specialist plays a critical role in the healthcare system by ensuring that patients receive the necessary medical services and treatments in a timely manner. This position involves reviewing and processing prior authorization requests from healthcare providers, verifying patient eligibility, and collaborating with insurance companies to facilitate approvals. The ideal candidate will possess strong attention to detail, excellent communication skills, and a solid understanding of medical terminology and coding.

Duties

· Review and assess prior authorization requests for medical procedures, services, and medications.

· Verify patient eligibility and benefits with insurance providers.

· Communicate effectively with healthcare providers to obtain necessary documentation for authorization.

· Utilize ICD-10 coding systems to accurately process requests.

· Maintain accurate records of all prior authorization activities in the medical office or managed care environment.

· Collaborate with other healthcare professionals to ensure compliance with regulations and policies.

· Stay updated on changes in insurance policies, medical coding practices, and managed care guidelines.

Schedule:

· 8:30AM to 5:00PM

· Monday - Friday

Requirements:

· Proficiency in medical terminology and understanding of medical records management.

· Experience with office operations in a medical or dental office setting.

· Knowledge of ICD-10 coding systems is essential.

· Familiarity with managed care processes and protocols.

· Strong organizational skills with the ability to manage multiple tasks simultaneously.

· Excellent verbal and written communication skills for effective interaction with providers, patients, and insurance representatives.

· Attention to detail to ensure accuracy in processing prior authorizations.

This position requires a dedicated professional who is committed to providing quality service within the healthcare system while ensuring that patients receive the necessary approvals for their treatments.