Prior Authorization Specialist

Job Summary
We are seeking a motivated and detail-oriented Prior Authorization Specialist to join our healthcare team. In this vital role, you will be responsible for managing the authorization process for medical and dental procedures, ensuring timely approval from insurance providers. Your expertise will help streamline patient care, reduce delays, and ensure compliance with healthcare regulations. This position offers an energetic environment where your proactive approach and knowledge of managed care will make a meaningful difference in patient outcomes.

Duties

• Review and analyze medical records, insurance information, and clinical documentation to prepare prior authorization requests.
• Submit authorization requests accurately using appropriate CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems.
• Follow up with insurance companies to track the status of authorization requests and expedite approvals.
• Communicate effectively with healthcare providers, patients, and insurance representatives to clarify documentation or resolve issues.
• Maintain detailed records of all authorization activities in compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations.
• Verify insurance coverage and benefits prior to submitting authorization requests to ensure eligibility.
• Stay current with changes in managed care policies, insurance requirements, and medical coding standards to optimize approval success.

Requirements

• Proven experience in medical office settings or healthcare environments, preferably with prior authorization responsibilities.
• Strong knowledge of managed care processes, insurance verification, and medical billing procedures.
• Familiarity with HIPAA regulations to ensure patient confidentiality and data security.
• Proficiency in CPT coding, ICD-9, ICD-10 coding systems, and medical terminology.
• Experience handling medical records, documentation review, and medical coding practices.
• Excellent communication skills for liaising with providers, insurance companies, and patients.
• Office experience in a fast-paced environment with attention to detail is essential; dental office experience is a plus. Join our team as a Prior Authorization Specialist and be part of a dynamic organization committed to delivering exceptional patient care through efficient authorization processes!

Pay: $150.00 - $200.00 per day

Work Location: Remote