Prior Authorization Specialist

Hoskinson Biotechnology • Gillette, WY

10h

About The Position

The Prior Authorization Specialist is responsible for ensuring that patients receive timely and accurate authorization for medical procedures, medications, and other healthcare services. This role involves extensive communication with insurance companies, healthcare providers, and patients to secure the necessary approvals and ensure compliance with all relevant policies and regulations.

Requirements

• High school diploma or equivalent required; Associate's or Bachelor's degree in healthcare administration, medical billing and coding, or a related field preferred.
• Minimum of 2 years of experience in a healthcare setting, preferably in prior authorization, medical billing, or a related field preferred.
• Excellent verbal and written communication skills.
• Ability to explain complex insurance and authorization processes clearly and concisely.
• Strong organizational skills and meticulous attention to detail. Ability to manage multiple requests and prioritize tasks effectively.
• Proficiency with healthcare information systems, electronic medical records (EMR), and prior authorization software. Familiarity with medical terminology, billing, and coding practices.
• Strong analytical and problem-solving skills.
• Ability to navigate complex insurance requirements and resolve authorization issues.
• Excellent customer service skills with a patient-centered approach.
• Ability to work effectively in a team environment and collaborate with various stakeholders.

Nice To Haves

• Certification in medical billing and coding (e.g., CPC, CMC) is a plus.

Responsibilities

• Review and process prior authorization requests for medical procedures, medications, and other healthcare services.
• Ensure all necessary clinical information and documentation are obtained and submitted to insurance companies.
• Track and follow up on outstanding prior authorization requests to ensure timely approvals.
• Serve as a liaison between healthcare providers, insurance companies, and patients.
• Communicate authorization status, requirements, and potential issues promptly to healthcare providers and patients.
• Provide clear and concise information regarding coverage, authorization criteria, and appeal processes.
• Maintain accurate and detailed records of all authorization requests, approvals, denials, and appeals.
• Ensure compliance with all relevant regulations, guidelines, and clinic policies.
• Prepare and submit appeals for denied authorizations when necessary.
• Address patient and provider inquiries regarding the prior authorization process.
• Provide exceptional customer service by resolving issues and answering questions efficiently and professionally.
• Work closely with healthcare providers and administrative staff to gather necessary information for authorization requests.
• Collaborate with billing and coding departments to ensure accurate submission of claims.
• Assist in the development and implementation of policies and procedures related to prior authorizations.

Benefits

• HEALTH INSURANCE: THE COMPANY COVERS 100% OF HEALTH INSURANCE PREMIUMS, INCLUDING MEDICAL, DENTAL, VISION, STD, LTD, AND LIFE INSURANCE COVERAGE.
• SUPPLEMENTAL INSURANCE: EMPLOYEES HAVE VOLUNTARY ACCESS TO ADDITIONAL POLICIES SUCH AS HOSPITAL, CANCER COVERAGE, ACCIDENT INSURANCE, AND VOLUNTARY LIFE THROUGH A SUPPLEMENTAL PROVIDER.
• RETIREMENT BENEFITS: ENJOY A GENEROUS RETIREMENT PLAN WITH A COMPETITIVE COMPANY MATCH—NO WAITING PERIOD REQUIRED!
• PTO: BENEFIT FROM GENEROUS PTO POLICY.
• PROFESSIONAL DEVELOPMENT: HOSKINSON HEALTH & WELLNESS CLINIC SUPPORTS THE PROFESSIONAL GROWTH OF ALL EMPLOYEES BY OFFERING ASSISTANCE FOR CONTINUING OR ADDITIONAL EDUCATION WITH HR APPROVAL.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 1-10 employees