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)