Pre-Authorization Specialist

$41,600 - $45,760/Yr

Gallo and Cho Eye & Facial Plastic Surgery - Dublin, OH

Full-time - Mid Level

Dublin, OH

About the position

We are seeking a detail-oriented and knowledgeable Prior Authorization Specialist to join our healthcare team. In this role, you will be responsible for obtaining prior authorizations for medical services and procedures, ensuring compliance with insurance requirements, and facilitating communication between healthcare providers and insurance companies. Your expertise in medical terminology and coding will be crucial in navigating the complexities of insurance verification and managed care processes. The ideal candidate will consistently demonstrate resilience, dedication, and a problem-solving mindset, committed to improving processes and supporting team members.

Responsibilities

• Review patient medical records to determine the necessity of prior authorization for specific treatments or procedures.
• Communicate with healthcare providers to gather necessary documentation and information required for authorization requests.
• Submit prior authorization requests to insurance companies, ensuring all required information is included for timely processing.
• Follow up on pending authorization requests, addressing any issues or additional information requests from insurers.
• Maintain accurate records of all authorization requests and outcomes within the medical office's system.
• Collaborate with medical coding staff to ensure proper coding (ICD-9, ICD-10) is applied to services requiring authorization.
• Stay updated on changes in insurance policies, managed care guidelines, and relevant medical terminology to ensure compliance.

Requirements

• Proficiency in medical terminology and understanding of medical coding practices (ICD-9, ICD-10).
• Experience working in a dental office or medical office setting is preferred.
• Strong knowledge of insurance verification processes and managed care systems.
• Excellent organizational skills with attention to detail to manage multiple authorization requests efficiently.
• Effective communication skills for liaising with healthcare providers, patients, and insurance representatives.
• Ability to work independently as well as part of a team in a fast-paced environment.
• Familiarity with electronic health records (EHR) systems and medical records management is advantageous.

Nice-to-haves

• Dental office experience

Benefits

• Paid time off