Prior Authorization Specialist

Job Overview
MUST HAVE EXPERIENCE WITH COVER MY MEDS!!!!

We are seeking a detail-oriented and organized Prior Authorization Specialist to join our healthcare team. Experience with CoverMyMeds is a huge plus! This role is essential in ensuring that patients receive the necessary approvals for medical services and procedures before they are performed. The ideal candidate will possess a strong understanding of managed care processes, medical terminology, and coding systems. You will work closely with healthcare providers, insurance companies, and patients to facilitate the authorization process efficiently.

Duties

• Review and process prior authorization requests for medical services and procedures.
• Verify patient insurance coverage and eligibility for services.
• Communicate with healthcare providers to obtain necessary documentation and clarify information as needed.
• Ensure compliance with HIPAA regulations while handling sensitive patient information.
• Utilize CPT coding, ICD-9, and ICD-10 codes accurately in the authorization process.
• Maintain detailed records of all authorization requests and outcomes in medical records.
• Collaborate with the billing department to resolve any discrepancies related to authorizations.
• Provide support for insurance verification processes as required.
• Assist in training new staff on prior authorization protocols and procedures.

Experience

• Previous experience in a managed care environment is preferred.
• Medical office experience with a solid understanding of medical terminology and coding practices is essential.
• Familiarity with HIPAA regulations to ensure patient confidentiality.
• Experience with insurance verification processes is highly desirable.
• Knowledge of dental office procedures may be beneficial but not required.
• Strong organizational skills and attention to detail are crucial for success in this role.
• Proficiency in managing medical records and documentation effectively.

Join our team as a Prior Authorization Specialist where you can make a significant impact on patient care by facilitating timely access to necessary medical services.