Prior Authorization Specialist

Prior Authorization Specialist-

exp-2+yrs

work from home

night shift

We are looking for an experienced Prior Authorization Specialist to join our team. The ideal candidate will be responsible for obtaining prior authorizations for medical procedures, treatments, and medications. This role is crucial in ensuring that services are approved by insurance companies before they are rendered, minimizing denials, and ensuring smooth financial operations.

Key Responsibilities

• Obtain prior authorizations from insurance providers for medical procedures, diagnostic tests, surgeries, and prescription medications.
• Review patient medical records and clinical documentation to ensure that prior authorization requests meet insurance requirements.
• Communicate with healthcare providers, insurance companies, and patients to gather the necessary information for authorizations.
• Track the status of authorization requests and follow up with insurance companies on pending approvals or denials.
• Resolve authorization issues, appeals, and discrepancies in a timely manner.
• Document all activities related to prior authorization in the medical billing system.
• Ensure compliance with HIPAA and other regulatory requirements.
• Stay updated on insurance guidelines and authorization protocols for various payers.

Qualifications

Education: High school diploma or equivalent required. Associates or Bachelors degree in healthcare administration or related field preferred.

Experience: Minimum of 2 years of experience in prior authorizations, medical billing.

Skills:

• Strong knowledge of insurance processes, medical billing, and coding (CPT, ICD-10, HCPCS).
• Familiarity with Electronic Health Record (EHR) and billing software.
• Excellent communication skills for interacting with insurance representatives, healthcare providers, and patients.
• Strong organizational skills and attention to detail.
• Ability to work independently and meet deadlines in a fast-paced environment.

Preferred Qualifications

• Experience with prior authorizations in a specialty practice (e.g., oncology, cardiology, orthopedics).
• Certification in Medical Billing (e.g., CPC, CPB, CHAA).
• Knowledge of Medicare, Medicaid, and commercial payer policies.
• Night Shift