Prior Authorization Specialist

Description

The Prior Authorization Specialist plays a critical role in the healthcare system by ensuring that patients receive the necessary medical services and treatments in a timely manner. This position involves reviewing and processing prior authorization requests from healthcare providers, verifying patient eligibility, and collaborating with insurance companies to facilitate approvals. The ideal candidate will possess strong attention to detail, excellent communication skills, and a solid understanding of medical terminology and coding.

Duties

• Review and assess prior authorization requests for medical procedures, services, and medications.
• Verify patient eligibility and benefits with insurance providers.
• Communicate effectively with healthcare providers to obtain necessary documentation for authorization.
• Utilize ICD-10 coding systems to accurately process requests.
• Maintain accurate records of all prior authorization activities in the medical office or managed care environment.
• Collaborate with other healthcare professionals to ensure compliance with regulations and policies.
• Stay updated on changes in insurance policies, medical coding practices, and managed care guidelines.

Schedule :

Requirements

This position requires a dedicated professional who is committed to providing quality service within the healthcare system while ensuring that patients receive the necessary approvals for their treatments.

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