Customer Service / Prior Authorization Representative

Gryphon Healthcare•Houston, TX

6d•Onsite

About The Position

We are seeking an enthusiastic and detail-oriented Customer Service / Prior Authorization Representative to join our team. In this role, you will serve as the first point of contact for our patients while also managing prior authorization requests to help ensure timely access to care. The ideal candidate will have prior authorization experience in a medical setting, with Radiology experience strongly preferred. You will work closely with our client medical offices, insurance carriers, and internal teams to obtain authorizations, verify benefits, resolve patient inquiries, and support the Medical Records Department.

Requirements

Minimum of one (1) year of customer service experience in a medical office, clinic, hospital, emergency room, or healthcare setting.
Minimum of one (1) year of prior authorization experience required.
Knowledge of insurance prior authorization processes and payer requirements.
Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans.
Ability to interpret Explanation of Benefits (EOBs).
Strong organizational, follow-up, and time management skills.
Excellent verbal and written communication skills.
Ability to multitask and prioritize in a fast-paced environment.
Detail-oriented with accurate data entry skills.
Proficiency with Microsoft Outlook and Windows-based computer systems.

Nice To Haves

Radiology prior authorization experience is strongly preferred.
Medical billing and insurance verification experience preferred.
Familiarity with EMR/EHR systems, EDI, and insurance portals.
Understanding of HIPAA regulations and patient confidentiality requirements.
Bilingual (English/Spanish) is a plus but not required.

Responsibilities

Answer incoming calls from patients and customers, identifying the type of assistance needed.
Obtain, submit, monitor, and document insurance prior authorizations for medical services and procedures.
Verify insurance eligibility, benefits, authorization requirements, and referral requirements.
Follow up with insurance carriers regarding pending or denied authorizations and appeals as appropriate.
Coordinate with physician offices, scheduling staff, and clinical personnel to obtain required documentation for authorization requests.
Ask appropriate questions and actively listen to identify customer concerns while accurately documenting information in company systems.
Research patient accounts and healthcare claims using multiple computer systems.
Ensure appropriate insurance benefits are applied to each patient account.
Resolve patient billing questions using clear, professional communication.
Process patient payments and generate patient statements.
Assist the Medical Records Department by retrieving records for patients, attorneys, and third-party vendors.
Meet established performance goals for quality, productivity, customer satisfaction, accuracy, and attendance.
Demonstrate excellence in customer service with every patient interaction.
Participate in continuing education to remain current on medical billing, insurance regulations, and prior authorization requirements.
Support other members of the Revenue Cycle team as needed.
Perform other duties as assigned.