Prior Authorization Specialist - Electronic Medical Records

Eagle Physicians • Greensboro, NC

2d • Hybrid

About The Position

Eagle Physicians & Associates is seeking a dynamic, self-motivated Prior Authorization Specialist to join our Eagle Medical Record Team. We offer a competitive salary, a collaborative work environment, and an outstanding benefits package designed to support both your personal and professional growth. This role involves processing prior authorization requests, reviewing patient medical records, verifying insurance information, and ensuring accurate documentation and communication with various stakeholders.

Requirements

• Knowledge of medical terminology, healthcare operations, insurance verification, and prior authorization processes.
• Knowledge of medical office procedures, clinical documentation, and applicable healthcare regulations.
• Understanding of HIPAA requirements and the proper handling of Protected Health Information (PHI).
• Ability to interpret insurance benefits, payer requirements, and medical necessity guidelines.
• Strong organizational skills with the ability to manage multiple priorities and meet deadlines.
• Excellent verbal and written communication skills with the ability to interact professionally with patients, providers, pharmacies, insurance carriers, and coworkers.
• Strong attention to detail and accuracy in documentation, data entry, and record maintenance.
• Proficiency in electronic medical records (EMR/EHR), insurance portals, and standard office software.
• Ability to maintain effective working relationships while providing exceptional customer service.
• Ability to exercise sound judgment, maintain confidentiality, and work independently in a fast-paced healthcare environment.
• Influenza vaccine is required as a condition of employment.

Nice To Haves

• Medical Assistant
• Licensed LPN
• 3+ years of medical office experience

Responsibilities

• Process prior authorization requests received by fax, phone, electronic portals, or other approved methods.
• Review patient medical records and supporting clinical documentation to determine authorization requirements.
• Verify patient insurance eligibility, benefits, and prior authorization requirements with insurance carriers.
• Prepare, complete, and submit prior authorization requests with accurate clinical documentation.
• Monitor authorization requests, follow up on pending or denied cases, and provide additional information as needed to facilitate approval.
• Document authorization determinations, communicate approval or denial to patients and pharmacies, and ensure authorization information is accurately recorded in the medical record.
• Maintain complete, accurate, and standardized documentation of all communications with patients, providers, insurance carriers, pharmacies, and other healthcare personnel.
• Obtain signed medical releases and other required patient documentation in accordance with organizational policies.
• Maintain organized work areas, restock supplies as needed, and follow established safety protocols, including the appropriate use of personal protective equipment (PPE).
• Protect patient confidentiality by complying with HIPAA regulations and safeguarding Protected Health Information (PHI) and confidential business information.
• Demonstrate professionalism, compassion, and excellent customer service when interacting with patients, visitors, providers, coworkers, pharmacies, and insurance representatives.
• Participate in staff meetings, committees, continuing education, and professional development activities to support ongoing growth and organizational initiatives.
• Support a collaborative, team-oriented work environment by assisting colleagues and contributing to departmental success.
• Uphold Eagle Physicians' Vision, Mission, Values, and Diversity, Equity, and Inclusion (DEI) principles through daily interactions and decision-making.
• Perform other duties and responsibilities as assigned.

Benefits

• Competitive salary
• Collaborative work environment
• Structured retention bonus program ($750 at 6 months, $750 at 12 months, $1,000 at 18 months, $1,000 at 24 months for eligible support staff hired on or after April 1, 2024, at 0.50 FTE or greater)
• Paid maternity/paternity leave (up to two weeks after one year of employment and 1,250 hours worked, prorated based on FTE status)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed