Prior Authorization Specialist

OverviewJob SummaryWe are seeking a detail-oriented and knowledgeable Prior Authorization Specialist to join our team. In this role, you will be responsible for managing the prior authorization process for medical procedures and services, ensuring compliance with insurance requirements while facilitating timely patient care. The ideal candidate will have a strong understanding of medical terminology, coding, and insurance verification processes.Responsibilities

• Review and process prior authorization requests for medical services and procedures
• Communicate with healthcare providers, patients, and insurance companies to gather necessary information
• Verify patient eligibility and benefits
• Utilize medical coding knowledge (ICD-10) to accurately document procedures and diagnoses
• Ensure compliance with HIPAA regulations while handling sensitive patient information
• Maintain accurate records of all authorization requests and follow up on pending authorizations
• Collaborate with dental and medical offices to streamline the authorization process
• Provide support in resolving any issues related to denied authorizations or appeals

• Previous experience in a medical office setting is preferred
• Proficiency in medical terminology and coding practices is essential
• Familiarity with managed care processes and insurance verification is highly desirable
• Strong organizational skills with attention to detail to manage multiple requests efficiently
• Excellent communication skills, both verbal and written, to effectively interact with various stakeholders

• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
• 401K
• Aflac