Prior Authorization Representative

Job Description
Prior Authorization Representative Job Description

Client Profile- An Indiana based Independent Physician-Owned radiology practices founded in 1967.

Job Summary- Prior Authorization Representative is responsible for securing inpatient/outpatient accounts by performing insurance verification, obtaining benefit information, calculating patient estimates and obtaining prior authorizations before service are rendered. Must be comfortable working with clinical professionals.

Job Duties

• Verify insurance eligibility, benefits, network status and create pre-service liability estimate.

• Ensure accurate ICD, CPT codes and related medical records are submitted in the authorization request.

• Secure prior authorizations of inpatient and outpatient imaging.

• Acts as a liaison between the payer and clinic schedulers/medical support.

• Follows up on delayed or denied authorizations requests and escalates for resolution.

• Create detail documentation and maintain/stores the authorization paper trail.

Requirements

Qualifications

• High School Diploma, 3+years of experience in a health care financial setting or medical office setting. Must have previous prior authorization experience.

• Excellent customer service skills, strong attention to details, multi-task as needed.

• Must be familiar with an EMR or HER; Microsoft Office 365

• Must be able to take responsibility and work under pressure. Work efficiently in a busy medical office.

• Must be a positive team player.

• Knowledge of ICD-10, CPT, and HCPCS codes specific to radiology is a plus.

• Proficient in medical terminology, especially radiological terms and procedures.

• Days/Hours: M/F 8a to 5pm (Availability to start as early as 7a and work as last as 6:00pm is a plus)

• Starting pay $20.00 to $21.00 hourly (Based on experience)