Medical Insurance Prior Authorization Specialist

Lee Obstetrics & Gynecology•Auburn, AL

9d•Onsite

About The Position

Lee Obstetrics and Gynecology is seeking a highly organized, detail-oriented Medical Insurance Prior Authorization Specialist to join their OBGYN practice. This position is responsible for managing the prior authorization process for obstetric and gynecologic services, procedures, diagnostic testing, and surgical services. The specialist will work closely with providers, surgery scheduling, billing staff, patients, and insurance companies to ensure required authorizations are obtained accurately and within the appropriate timeframe. The ideal candidate is knowledgeable about health insurance requirements, comfortable communicating with insurance companies, and able to manage multiple time-sensitive requests while maintaining a high level of accuracy.

Requirements

High school diploma or equivalent required.
Knowledge of medical terminology required.
Strong attention to detail and accuracy.
Excellent organizational and time-management skills.
Ability to prioritize multiple requests and meet strict deadlines.
Strong written and verbal communication skills.
Ability to communicate professionally with insurance representatives, patients, providers, and coworkers.
Ability to work independently while functioning effectively as part of a team.
Strong problem-solving and follow-up skills.

Nice To Haves

Previous experience in medical insurance, prior authorization, medical billing, referrals, or revenue cycle management preferred.
OBGYN or specialty-practice experience strongly preferred.
Familiarity with CPT and ICD-10 coding preferred.
Knowledge of commercial insurance, Medicare, Medicaid, and managed-care plans preferred.
Experience using insurance payer portals preferred.
Experience with electronic medical records and practice-management systems preferred.

Responsibilities

Verify patient insurance eligibility and benefits when necessary.
Determine whether OBGYN services and procedures require prior authorization.
Review insurance plans for authorization requirements and payer-specific guidelines.
Obtain and review necessary clinical documentation from providers and clinical staff.
Submit prior authorization requests through payer portals, fax, telephone, and any other required methods.
Obtain authorizations for services including, but not limited to: Obstetric and gynecologic procedures, Surgical procedures, Diagnostic testing, Infertility-related services when applicable, In-office procedures, Other services designated by the patient’s insurance plan.
Track all pending authorization requests and follow up with insurance companies in a timely manner.
Record authorization numbers, approval dates, expiration dates, approved services, units, and other pertinent information.
Ensure authorization information is accurately documented in the patient’s account and/or electronic medical record.
Communicate authorization status with providers, nurses, surgery schedulers, billing staff, and patients as appropriate.
Notify appropriate staff immediately when an authorization is denied, delayed, or requires additional clinical information.
Request additional documentation from clinical staff when required by the insurance company.
Assist with insurance denials, reconsiderations, appeals, and peer-to-peer requests related to prior authorization.
Monitor authorization expiration dates and obtain extensions or new authorizations when necessary.
Ensure approved services correspond with the correct procedure, diagnosis, provider, facility, and date of service when applicable.
Identify authorization-related issues that could result in claim denials or delays in patient care.
Maintain accurate and organized authorization records.
Maintain confidentiality and comply with HIPAA and practice policies.
Stay current with changes to insurance plans, payer requirements, authorization procedures, and OBGYN services.
Perform other billing and revenue-cycle duties as assigned.
Develop a strong working knowledge of authorization requirements related to Gynecology, Office procedures, Ultrasounds and diagnostic testing, Colposcopy and related procedures, Endometrial procedures, Hysteroscopy, D&C procedures, Ablation procedures, Incontinence procedures, Pelvic floor procedures, Gynecologic surgeries, Other procedures requiring payer authorization.