Prior Authorization Representative

MFM Health • Middleton, MA

40d • $20 - $24 • Onsite

About The Position

MFM Health is looking for a diligent and detail-oriented Prior Authorization Representative to join our team. This in office full-time role is dedicated to managing prior authorizations for diagnostic services, medications, and treatments to ensure timely patient care. The ideal candidate will bring experience in prior authorizations, strong organizational skills, and the ability to work independently within a collaborative healthcare setting.

Requirements

• High school diploma or equivalent required; Associate's Degree or relevant certification in medical billing, coding, or healthcare administration preferred.
• At least 1-2 years of experience in prior authorizations, insurance verification, or medical billing within a healthcare setting.
• Strong understanding of insurance policies, medical terminology, and prior authorization requirements.
• Proficiency with electronic health records (EHR) and prior authorization submission platforms.
• Excellent organizational, communication, and problem-solving skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Ability to sit for extended periods working on a computer.
• Manual dexterity for handling paperwork and office equipment.

Responsibilities

• Submit and track prior authorization requests for prescribed medical services, i.e., diagnostic imaging and genetic testing.
• Ensure all necessary patient information, clinical documentation, and authorization forms are complete before submission.
• Follow up with insurance providers to secure timely approval and resolve issues that may cause delays.
• Review patient insurance plans to confirm coverage and authorization requirements for specific services.
• Maintain compliance with payer guidelines and changes in authorization requirements to minimize claim denials.
• Document and manage appeals and reconsideration requests for denied authorizations, providing additional information as needed.
• Record all prior authorization activities in the electronic health record (EHR), maintaining accurate and detailed notes.
• Track the status of each authorization and provide regular updates to healthcare providers and patients.
• Generate reports on prior authorization metrics to identify and improve process efficiencies.
• Communicate effectively with patients to inform them of the authorization process, status updates, and any expected timelines.
• Work closely with physicians and nursing staff to ensure coordinated and timely care.
• Act as the primary contact for authorization inquiries, supporting both internal staff and external insurance representatives.
• Contribute to process improvement initiatives to streamline prior authorization workflows and reduce turnaround times.
• Identify common issues in authorizations and proactively seek solutions to improve overall efficiency and accuracy.

Benefits

• Enhanced Benefits Package: Enjoy a comprehensive benefits package that includes discretionary paid time off to ensure a healthy work-life balance and a 401(k) plan with employer match.
• Professional Growth Environment: At MFM Health, we are committed to your professional development. We offer continuous opportunities for learning and career advancement in a supportive and collaborative environment.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED