Job Description

Job Summary:
We are seeking a skilled Medical Billing Specialist with experience in prior authorization to join our team. The ideal candidate will be responsible for managing the prior authorization process, ensuring timely and accurate approvals for medical services and procedures.
Key Responsibilities:
Prior Authorization: Manage and process prior authorization requests for medical services and procedures, ensuring all necessary documentation is submitted accurately and promptly.
Verification: Verify insurance benefits and coverage requirements to determine the need for prior authorization and ensure compliance with payer guidelines.
Communication: Communicate with healthcare providers, insurance companies, and patients to obtain necessary information, follow up on authorization status, and resolve any issues.
Documentation: Maintain detailed records of all prior authorization requests, approvals, and denials, ensuring compliance with internal policies and payer requirements.
Follow-Up: Monitor and track the status of authorization requests, addressing any delays or issues to expedite approvals.
Compliance: Ensure adherence to relevant regulations, payer guidelines, and company policies regarding prior authorization processes.
Reporting: Generate and review reports related to prior authorization activities, identifying trends and areas for improvement.
Desired Candidate Profile:
Should have 2 years of experience in medical billing, preferably in the prior authorization.
Anatomy Physiology & Medical Terminology.
Excellent ability to read and interpret comprehensive documents.
Minor ability to research and demonstrate patience.
Formal compliance.
Exhaustive reading skills for thorough review of authorization requests and related documentation.

 

Skills Required