Pre-Authorization Specialist

Job Description

Job Description

Pre-Authorization Specialist (Full-Time)

“The Largest Independent Established Multi-Specialty Group in Central North Carolina is Seeking a Pre-Authorization Specialist (Full-Time) to join our Team”

VOTED “BUSINESS OF THE YEAR” 2018

VOTED ONE OF THE “FASTEST GROWING COMPANIES IN THE TRIAD” 2019, 2020, 2021, 2022

Our mission at Bethany Medical is to provide excellent care through a Multi-Specialty approach from prevention to intervention of potentially life-threatening health problems.

Summary

The Pre-Authorization Specialist is responsible for obtaining and verifying insurance authorizations for medical procedures, diagnostic tests, and treatments prior to service. This role ensures that all required pre-certifications are secured promptly to facilitate smooth patient care delivery and accurate billing. The ideal candidate is detail-oriented, highly organized, and able to communicate effectively with patients, providers, and insurance representatives.

Key Responsibilities

• Review scheduled services to determine if pre-authorization is required based on insurance guidelines.
• Obtain pre-certifications and prior authorizations from insurance carriers for procedures, diagnostic imaging, referrals, and treatments.
• Verify patient insurance coverage, eligibility, and benefits.
• Document all authorization information accurately in the patient’s electronic medical record (EMR).
• Communicate with providers and clinical staff regarding authorization status or issues.
• Follow up on pending authorizations to ensure timely approval.
• Maintain up-to-date knowledge of payer requirements and policy changes.
• Provide excellent customer service to patients and act as a liaison between the clinic, patients, and insurance companies.
• Assist with appeals or resubmissions when authorizations are denied.
• Support the billing department with claims-related authorization inquiries.

Qualifications

Minimum 1–2 years of experience in medical insurance verification, pre-authorization, or medical billing preferred.

Skills :

Knowledge of insurance processes, CPT / ICD-10 coding, and medical terminology.

Work Environment

Competitive Benefit Package Includes :

About Bethany Medical

Bethany Medical (BM) is a multi-specialty medical practice serving the triad and surrounding communities since 1987. BM is open seven days a week, with 16 convenient locations in Greensboro, Winston-Salem, High Point, Kernersville, Jamestown, North Wilkesboro, and Mt. Airy, North Carolina. Bethany Medical offers Urgent Care, Primary Care, Pain Management, diagnostic testing, and specialty care services onsite. Bethany Medical is staffed with board-certified Physicians and Advanced Clinical Providers representing eight medical specialties. Bethany providers are known for prompt and personalized care. BM employs over 65 providers and more than 550 full-time and part-time employees. You are invited to explore the scope of services on our website at www.mybethanymedical.com.

“Your Health is Our Concern”

About the Triad

The Triad area includes Greensboro (the 3rd-largest city in NC), Winston-Salem, High Point, and the surrounding area. The Triad is centrally located in NC with a population of 1.9 million. The Triad is 1 hour from the mountains and 3 hours from the beach. Charlotte and Raleigh are 1.5 hours from the Triad. The Triad offers all the amenities of a larger city without all the traffic. The Piedmont Triad International Airport is conveniently located in Greensboro with convenient non-stop flights to most major cities. Enjoy an outstanding quality of life with no shortage of arts, entertainment, recreation, shopping, and hundreds of restaurants. The Triad is home to 85 colleges and universities, including Wake Forest University, High Point University, UNC-Greensboro, NC A&T, Guilford College, Bennett College, and Greensboro College.

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