Responsible for obtaining and coordinating prior authorizations and insurance approvals for medical services, procedures, medications, and diagnostic testing. Works closely with healthcare providers, insurance companies, patients, and clinical staff to ensure services are authorized appropriately and in a timely manner.
Key responsibilities include:
- Review physician orders, clinical documentation, and patient information to determine authorization requirements.
- Submit and track prior authorization requests to insurance companies and other payers.
- Verify patient eligibility, benefits, coverage, and authorization requirements.
- Communicate with insurance companies regarding authorization status, clinical criteria, and required documentation.
- Obtain and document authorization numbers, effective dates, approved services, and other relevant information.
- Follow up on pending, denied, or incomplete authorization requests and take appropriate action.
- Coordinate with physicians, nurses, clinical staff, and other departments to obtain necessary clinical documentation.
- Identify missing or insufficient information that may delay authorization and communicate requirements promptly.
- Maintain accurate and timely documentation in electronic medical records and/or authorization systems.
- Monitor authorization deadlines and ensure requests are completed within payer and organizational timeframes.
- Assist with authorization denials, reconsiderations, and appeals as appropriate.
- Maintain confidentiality of patient information in accordance with HIPAA and organizational policies.
- Stay current with payer policies, authorization requirements, medical necessity guidelines, and changes in insurance regulations.
- Perform other administrative and authorization-related duties as assigned.
Requirements & Qualifications
Required qualifications:
- High school diploma or equivalent required.
- Previous experience in healthcare, medical billing, insurance verification, prior authorization, or a related field preferred.
- Knowledge of health insurance plans, payer requirements, and authorization processes.
- Strong computer skills and experience working with electronic medical records and/or healthcare software.
- Excellent attention to detail and organizational skills.
- Strong written and verbal communication skills.
- Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
- Ability to handle confidential patient and medical information appropriately.
Preferred qualifications:
- Certification in healthcare administration, medical assisting, health information management, or a related field.
- Experience with Medicare, Medicaid, commercial insurance, or managed care plans.
- Experience with prior authorization portals and payer websites.
- Familiarity with medical terminology, CPT/HCPCS codes, ICD-10 codes, and medical necessity criteria.
- Experience handling authorization denials, peer-to-peer requests, or appeals.
- Certification such as Certified Professional Coder (CPC), Certified Medical Administrative Assistant (CMAA), or Certified Revenue Cycle Representative (CRCR) is a plus.
Benefits & Perks
Benefits offered:
- 401(k)
- Dental insurance
- Employee discount
- Health insurance
- Paid time off
Location
El Paso, Texas, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
1 month ago
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