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Prior Authorization Specialist

Posted: May 22, 2024
Salary:US$19 - US$21 per hour
Location:Town of Mount Pleasant
Job type: Contract
Discipline:Revenue Cycle
Work Location:On-site

Job description

We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our pediatric outpatient clinic. The Prior Authorization Specialist will be responsible for obtaining prior authorizations from insurance companies to ensure timely approval for medical services and procedures provided to pediatric patients. The ideal candidate will have a strong understanding of insurance verification, prior authorization processes, and excellent communication skills to liaise with insurance companies, healthcare providers, and patients.
- Review and verify insurance coverage for pediatric patients prior to services being rendered.
- Coordinate with healthcare providers to gather necessary medical documentation for prior authorization requests.
- Submit prior authorization requests to insurance companies in a timely manner and follow up on the status of pending requests.
- Communicate with insurance companies to resolve any issues that may arise during the prior authorization process.
- Update patient records with prior authorization information and ensure accurate documentation.
- Educate patients and families on the prior authorization process, insurance coverage, and potential out-of-pocket expenses.
- Work closely with the billing department to ensure accurate billing of authorized services.
- Stay informed about changes in insurance policies, regulations, and guidelines related to prior authorizations.
- High school diploma or equivalent required; Associate's or Bachelor's degree in a related field preferred.
- Minimum of 2 years of prior authorization experience in a healthcare setting, preferably in pediatrics.
- Strong knowledge of insurance verification and prior authorization processes.
- Familiarity with medical terminology and coding (ICD-10, CPT).
- Excellent communication skills with the ability to interact professionally with patients, healthcare providers, and insurance companies.
- Proficient in using electronic health records (EHR) systems and Microsoft Office applications.
- Detail-oriented, organized, and able to work efficiently in a fast-paced environment.
- Ability to maintain patient confidentiality and adhere to HIPAA regulations.
Schedule: M-F 8-4:30pm
Pay: $19-$21/hr
If you are passionate about ensuring pediatric patients receive the care they need by navigating the insurance authorization process effectively, we invite you to apply for the Prior Authorization Specialist position at our pediatric outpatient clinic.
Join our dedicated team and make a difference in the lives of children and families in our community.