Prior Authorization Representative

Clinical Associates•Towson, MD

3d•Onsite

About The Position

Clinical Associates is a premier multi-specialty physicians' practice connecting patients to integrated medical care across cardiology, podiatry, and other specialties. They offer unique services like a nuclear stress testing facility. They are seeking an experienced and detail-oriented Prior Authorization Representative to join their Cardiology team. The ideal candidate will have 1-2 years of experience in a healthcare setting with a strong understanding of insurance verification, eligibility, and obtaining prior authorizations for office procedures and diagnostic testing. The role requires excellent customer service and teamwork skills.

Requirements

High School Diploma or equivalent.
Medical office or health care experience is required.
1-2 years of proven experience in healthcare insurance verification / prior authorization or billing is required.
Strong attention to detail and organizational skills.
Strong time management skills.
Knowledge and understanding of CPT/ICD 10 coding and billing protocols.
Excellent verbal communication skills with ability to hear and to speak standard English clearly and concisely.
Excellent written communication skills with ability to read, write and spell standard English clearly and concisely.
Ability to interact effectively with culturally diverse patients, practitioners, and employee population.
Ability to convey a positive attitude and project a professional image.
Ability to remain flexible and maintain confidentiality.
Possesses excellent time management skills.
Requires lengthy periods of sitting, intermittent standing, reaching, and bending.

Nice To Haves

Specialty medicine and/or Cardiology experience.
Experience with EPM/EMR - specifically NextGen is a plus.

Responsibilities

Runs appointment lists and verifies insurance coverage, identifying patients needing prior authorizations for appointments, procedures, and diagnostic testing.
Completes the prior authorization process two weeks prior to scheduled appointments.
Contacts patients to inform them of their financial out-of-pocket costs (co-pay, deductible, co-insurance).
Confirms receipt of referrals before scheduled appointments.
Contacts primary care providers or other healthcare facilities to obtain referrals or missing information.
Contacts insurance companies to confirm coverage or resolve billing issues, discrepancies, or denials.
Enters and updates patient demographics, insurance information, and authorization/referral tracking in the EMR system.
Schedules appointments.
Performs other duties as assigned to support department workflow efficiency.