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Eligibility & Prior Authorization Specialist

Eligibility & Prior Authorization Specialist

Hera Women's HealthLas Vegas, NV, US
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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.

    • Requirements :

  • 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 women’s 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 Powered by JazzHR
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    Prior Authorization Specialist • Las Vegas, NV, US

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