Prior- Authorization Specialist

The Prior Authorization Specialist is a key member of the healthcare team, primarily responsible for obtaining pre-approval from insurance companies for patient medications and treatments.

This role is crucial in ensuring that patients receive the necessary healthcare services without undue delay or financial burden.

Core Responsibilities:

• Review and interpret physician orders and patient medical records to determine the necessity and accuracy of prior authorization requests.
• Contact insurance providers to verify patient coverage and benefits specific to prescribed medications and treatments.
• Submit detailed 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 that may arise.
• Communicate effectively with patients regarding the status of their authorization, including any additional information or action required on their part.
• Adhere to all healthcare regulations, including HIPAA, to ensure patient privacy and the confidentiality of medical information.

Skills and Qualifications:

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

Candidates can shar their resume on rarravalli@primehealthcare.com/ 9154961699.