Eligibility and Prior Authorization Specialist

My obgyne

is seeking a detail-oriented and knowledgeable Eligibility and Prior Authorization Specialist to join our practice. The ideal candidate will be responsible for verifying patient benefits and ensuring compliance with insurance guidelines.

Responsibilities :

Verify patient insurance benefits and coverage for OBGYN services in clinic.

Obtain prior authorizations and pre-certifications for treatments as required by insurance providers.

Communicate with insurance companies, patients, and healthcare providers to resolve any authorization or benefits-related issues.

Maintain accurate records of authorizations, approvals, and denials in the electronic health record (EHR) system.

Educate patients about their insurance benefits, coverage limitations, and out-of-pocket costs.

Work closely with the billing department to address claim denials related to authorization issues.

Stay up to date with insurance policies, coding changes, and payer requirements.

Provide administrative support to the practice as needed, including scheduling and coordinating patient services.

Requirements :

• Minimum of 1 year of experience in completing prior authorization for a medical facility;

PREFERRED

in an OBGYN or women's health setting.

Medical Assistance experience

PREFERRED

Strong understanding of insurance policies, prior authorization processes, and medical billing.

Proficiency in electronic health records (EHR) preferably AthenaOne.

Excellent communication and customer service skills.

Strong attention to detail and ability to work efficiently in a fast-paced environment.

Benefits :

Salary based on experience

Health, dental, and vision insurance

Life insurance

401(k) with employer matching after 1 year of service

Paid time off (PTO) and holidays