Experienced Prior Authorization Specialist

We are a busy private medical and surgical practice that is seeking to hire a full-time experienced Prior Authorization Specialist . We are a single-specialty surgical clinic in Boise, ID open Monday through Friday. Salary is dependent on experience and comprehensive benefits are available. If you are looking for a stable, fast-paced, growing company that is committed to innovation, excellence and integrity, we would love to hear from you!

The duties for this position consist of submitting prior authorizations for medical and surgical services. The prior authorization process includes:

• Authorization Submission: Initiate and process pre-authorization requests via phone or online portals, providing necessary clinical documentation.
• Verification: Confirm patient insurance eligibility, benefits, and coverage requirements for specific surgical procedures.
• Create Estimates: Create estimates based on the service and patient's specific benefits
• Denial Management: Follow up on denials, submit appeals, and secure medical necessity documentation to overturn denied services.
• Communication: Act as the liaison between physicians, patients, and insurance payers regarding authorization status.
• Record Keeping: Accurately document all interactions, approvals, and denials in the Electronic Health Record (EHR) system.
• Compliance: Adhere to regulatory, HIPAA, and organizational policies, managing urgent/expedited requests within required timeframes.

As a member of the billing team, you will also be responsible for patient communication and patient assistance with billing questions.

Successful candidates must have a minimum of 3 years of prior authorization experience and demonstrated experience in the following areas:

• Comprehension of the billing process
• Efficient with ICD-10 (diagnosis), CPT(procedure) codes and modifiers
• Knowledge of medical terminology
• Proficient in Excel, Word and 10key data entry
• Strong attention to detail and ability to work in a production-focused environment
• Team Player with solid interpersonal skills
• Medicare &/or Medicaid knowledge

If you have the necessary qualifications and experience for this position, we would like to hear from you.

Job Type: Full-time

Pay: From $22.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Experience:

• Medical billing: 3 years (Preferred)

Work Location: In person