Eligibility & Prior Authorization Specialist

Overview

Job Title : Eligibility and Prior Authorization Specialist

Location : Las Vegas, NV

Job Type : Full-Time

Job Summary : My OBGYN 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, obtaining prior authorizations for procedures and medications, and ensuring compliance with insurance guidelines.

Responsibilities

Verify patient insurance benefits and coverage for OBGYN services, including office visits, diagnostic tests, and surgical procedures.

Obtain prior authorizations and pre-certifications for procedures, treatments, and medications 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.

Qualifications

This position is based in our Centennial Hills office. Candidates must be able to reliably commute.

Minimum of 1 year of experience in completing prior authorization for a medical facility; PREFERRED in an OBGYN or womens 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

Competitive salary based on experience

Health, dental, and vision insurance

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

Paid time off (PTO) and holidays

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