Prior Authorization Specialist Jobs

About The Position

Requirements

• High School Diploma
• Knowledge of the health care field with regards to insurance carrier regulations
• Prior experience as a Medical Assistant
• Willingness and ability to quickly learn new software systems and workflows
• Comfort with, and reliability in, performing repetitive or detail‑oriented (tedious) tasks accurately and efficiently.
• Good interpersonal and communication skills
• Ability to project a pleasant and professional image
• Ability to effectively manage conflicts and resolve problems

Nice To Haves

• No experience required. Full training provided.

Responsibilities

• Contact insurance companies to verify benefits eligibility
• Collaborate with Refuah providers to resolve and appeal denied authorizations
• Ensure all services have prior authorizations.
• Utilize EMR system checking encounters when necessary and assign to the appropriate provider.
• Maintain knowledge of Medicaid and third party insurance requirements
• Verify insurance for in-network or out-of-network benefits
• Pre-certify services including surgery, office visits, diagnostic testing or any procedure that requires pre-certification
• Review Pediatric referrals from previous day and help schedule appointments
• Maintain strict patient confidentiality
• Maintain authorization records documentation
• Complies with applicable policies and procedures and supports the Compliance Program
• Contributes to organizational operations by performing other duties as may be required

Benefits

• Flexible schedules for maximum work-life balance