Prior Authorization Specialist

Job Title: Prior Authorization Representative

Location: Stamford, Connecticut

Pay: $19 - $22/hr

Hours: 8am - 4pm or 9am - 5pm, Monday - Friday

Start Date: ASAP

Job Summary:

The Prior Authorization Representative is responsible for securing insurance pre-certification and pre-authorization for scheduled Infusion Center services and treatments. This on-site role involves direct communication with patients, staff, and providers. The representative will pre-register patients in Meditech, verify insurance eligibility, and obtain necessary authorizations from payers. This position serves as the primary liaison within the Infusion Center, working closely with referring provider offices, patient access staff, insurance carriers, and patients to ensure smooth and timely processing of insurance authorizations.

Key Responsibilities:

1. Review referring physician orders and documentation to ensure compliance with insurance protocols for authorization.
2. Pre-register patients, verify insurance, and obtain authorizations in advance of scheduled and urgent infusion services, documenting all authorizations in Meditech.
3. Communicate with Infusion Center staff and pharmacy regarding payer requirements for drug supplies and assist with tracking shipments for patient treatments.
4. Update Infusion Center and patient access staff on the status of pending authorizations, advising on rescheduling or cancellations if necessary.
5. Monitor any changes in treatment orders or appointment dates and ensure authorizations are updated accordingly, documenting all changes in Meditech.
6. Act as a liaison between referring providers, patients, and insurance carriers, facilitating communication and obtaining additional documentation as needed.
7. Coordinate peer-to-peer reviews between payers and referring providers to secure authorizations.
8. Participate in process improvement initiatives related to insurance verification, pre-registration, and authorization management.
9. Maintain effective communication and professional relationships with patients, providers, and staff, ensuring the accuracy of all demographic, billing, and clinical information.
10. Attend staff meetings, participate in continuing education, and collaborate with various departments to enhance service delivery.
11. Uphold patient confidentiality and privacy, disclosing information only when necessary for the patient's best interests.

Qualifications/Requirements:

- High School Diploma or equivalent.

- Minimum of 2 years of experience in medical coding and/or billing, with knowledge of CPT/HCPCS and ICD-10 coding; familiarity with IV drug administration coding and billing is a plus.

- Strong computer skills, particularly in Microsoft Outlook, Word, and Excel.

- Ability to multi-task, adapt to new systems, and work effectively under pressure.

- Excellent communication skills, both verbal and written; bilingual skills are a plus.

- Professionalism, respect, and a commitment to providing high-quality customer service.

- Dependability, punctuality, and a strong sense of integrity and accountability.

- Ability to work well as part of a team and respond positively to direction and constructive feedback.

- Adherence to departmental and organizational policies, with a commitment to continuous learning and development.