Pre-Authorization Specialist

Georgia Eye Institute of the Southeast LLC • GA

75d

About The Position

The Pre-Authorization Specialist is responsible for ensuring that all medical services requiring pre-authorization are approved by insurance providers before patient appointments or treatments. This role involves working closely with healthcare providers, insurance companies, and patients to confirm that all required pre-certifications and authorizations are obtained efficiently. The specialist will play a key role in minimizing delays in patient care, reducing claim denials, and ensuring compliance with insurance policies and procedures.

Requirements

• High school diploma or GED required; associate degree in finance, accounting, or healthcare administration preferred.
• 1-2 years of experience in healthcare pre-authorization, billing, or insurance verification, preferably in a medical office or hospital setting.
• Proficiency in practice management software, electronic health records (EHR), and Microsoft Office (Excel, Word, Outlook and Teams).
• Strong understanding of medical terminology, ICD-10 and CPT coding, and insurance industry practices.
• Exceptional attention to detail and accuracy in financial analysis and data entry.
• Strong organizational and time management skills with the ability to handle multiple tasks and prioritize effectively.
• Excellent verbal and written communication skills, with the ability to communicate clearly with patients, staff, and external parties.
• Strong analytical and problem-solving skills, with the ability to identify and resolve discrepancies in patient accounts.
• Ability to work collaboratively with other departments and contribute to a positive team environment.

Responsibilities

• Obtain prior authorizations for required medical procedures, diagnostic tests, surgeries, medications, and treatments.
• Verify patient insurance coverage and eligibility for scheduled services.
• Submit necessary documentation and clinical information to insurance companies to facilitate approval of services.
• Communicate effectively with insurance providers, medical staff, and patients regarding authorization status, requirements, and any issues that may impact treatment.
• Collaborate with healthcare providers to gather additional information needed for authorization approvals.
• Educate patients on their coverage details, out-of-pocket responsibilities, and any prior authorization requirements.
• Maintain accurate records of authorization status, approvals, denials, and any related communications.
• Track and follow up on pending authorizations to ensure timely responses and avoid delays in patient care.
• Document all actions taken in patient records and keep detailed logs for audit and billing purposes.
• Assist with addressing denied authorizations by gathering additional information or resubmitting requests as needed.
• Work with billing and claims departments to resolve pre-authorization issues that result in claim denials.
• Monitor trends in authorization denials to identify and communicate areas for improvement.
• Stay up-to-date on insurance company policies, state and federal healthcare regulations, and pre-authorization requirements.
• Adhere to all HIPAA regulations and ensure patient confidentiality throughout the pre-authorization process.
• Participate in training and quality assurance programs to maintain a high standard of work.

Benefits

• Competitive salary based on experience.
• Comprehensive benefits package, including health and dental insurance.
• Paid time off (PTO).
• Opportunities for professional development and advancement.

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 11-50 employees