Prior Authorization Specialist / Medical Assistant

Horizon Family Medicine • Clayton, NC

418d • $37,440 - $43,680

About The Position

The Prior Authorization Specialist plays a crucial role in the healthcare system by ensuring that patients receive the necessary approvals for medical procedures and treatments. This position involves working closely with healthcare providers, insurance companies, and patients to facilitate the authorization process efficiently and accurately. The ideal candidate will possess a strong understanding of medical terminology, coding, and compliance regulations to navigate the complexities of prior authorizations effectively.

Requirements

• Proficient in medical terminology and coding practices, including ICD-10 and ICD-9.
• Experience working in a medical office or dental office environment.
• Strong understanding of managed care processes and insurance verification.
• Excellent organizational skills with attention to detail.
• Ability to communicate effectively with healthcare professionals, patients, and insurance representatives.
• Knowledge of HIPAA regulations to ensure confidentiality and compliance.
• Proficient in using office software and electronic health record systems.

Nice To Haves

• Insurance verification: 1 year (Preferred)

Responsibilities

• Review and process prior authorization requests for medical services and procedures.
• Communicate with healthcare providers to gather necessary documentation and information.
• Verify patient eligibility and benefits with insurance companies.
• Utilize ICD-10 and ICD-9 coding to ensure accurate representation of diagnoses and procedures.
• Maintain compliance with HIPAA regulations while handling sensitive patient information.
• Collaborate with dental offices and managed care organizations to streamline authorization processes.
• Document all interactions and maintain accurate records of authorization requests in the system.
• Follow up on pending authorizations to ensure timely approvals.

Benefits

• Health savings account
• Health insurance
• Dental insurance
• 401(k)
• Paid time off
• Vision insurance
• 401(k) matching
• Life insurance
• Referral program

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: No Education Listed