Job Description

Job Description

Job Description

Job Summary :

The Prior Authorization Specialist is a vital member of the healthcare team. They are responsible for managing the pre-approval process for patient treatments and medications with insurance companies. This role is crucial in ensuring that patients receive necessary healthcare services without undue delay or financial burden. This role requires a balance of healthcare knowledge, administrative skills, and a compassionate approach.

Essential Functions:

• Review and interpret physician orders and patient medical records to assess the Patient/Client Services the necessity and accuracy of prior authorization requests.
• Contact insurance providers to verify patient coverage and benefits for prescribed medications and treatments
• Submit authorization requests through electronic health records (EHR) systems, online portals, or via telephone.
• Collaborate with healthcare providers to gather additional information or clarification needed for prior authorization submissions.
• Monitor and track the status of submitted authorizations, following up as necessary to resolve delays or issues.
• Communicate effectively with patients regarding the status of their authorization, including any additional information or action required on their part.
• Adhere to healthcare regulations, including HIPAA, to ensure patient privacy and confidentiality of medical information.
• Other duties as assigned.

Skills and Qualifications:

• Proficiency in medical billing software and electronic health records systems.
• Familiarity with medical terminology and understanding of ICD-10 and CPT codes.
• Strong organizational skills and the ability to prioritize tasks in a fast-paced environment.
• Excellent communication and customer service skills, with an empathetic regard for patient needs.
• Experience with multitasking and meeting strict deadlines while maintaining attention to detail.
• Ability to work independently and as part of a team, with a commitment to collaborative problem-solving.

Educational Experience:

• High school diploma or equivalent is required.
• Post-secondary courses in Medical Terminology, Diagnosis and CPT Coding, and Anatomy & Physiology are preferred.
• A graduate of a Medical Assistant, Health Unit Coordinator, or Health Care Business Service program is advantageous.

Experience:

• A minimum of two years' experience in a medical business office or healthcare setting involving customer service or patient-facing responsibilities is required.

Medical w/Vision

Dental

Paid Time Off

Sick Time

403B

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