Prior Authorization Representative

Job Overview We are seeking a dynamic and detail-oriented Prior Authorization Representative to join our healthcare team. In this vital role, you will serve as the key liaison between healthcare providers, insurance companies, and patients to facilitate timely approval of medical services, procedures, and medications. Your energetic approach will help streamline the authorization process, ensuring patients receive the care they need without delay. This position offers an exciting opportunity to make a meaningful impact on patient outcomes while working in a fast-paced, collaborative environment. Duties • Review and interpret medical documentation, including medical records, clinical notes, and referral information to determine authorization eligibility. • Communicate proactively with healthcare providers to gather necessary information for prior authorization requests. • Submit detailed authorization requests through insurance portals or fax systems, ensuring accuracy and completeness. • Follow up regularly with insurance companies to track the status of pending approvals and resolve any issues promptly. • Maintain comprehensive records of all authorization activities in compliance with HIPAA regulations and organizational policies. • Verify insurance coverage and benefits prior to submitting authorization requests to ensure proper billing procedures. • Stay current with managed care policies, CPT (Current Procedural Terminology) codes, ICD (International Classification of Diseases) codes including ICD-9 and ICD-10, and other coding standards relevant to medical billing and documentation. Qualifications • Proven experience in managed care environments or medical office settings, demonstrating familiarity with insurance verification and prior authorization processes. • Strong knowledge of medical terminology, medical records management, and medical coding practices such as CPT, ICD-9, ICD-10, and ICD coding systems. • Prior experience working in dental or medical offices is highly desirable. • Excellent communication skills for effectively liaising with healthcare providers, insurance representatives, and patients. • Ability to navigate insurance portals and electronic health record (EHR) systems efficiently. • Understanding of HIPAA compliance requirements to protect patient confidentiality at all times. • Office experience that includes handling medical documentation, insurance verification, and data entry tasks. Join us in this energetic role where your attention to detail and proactive communication will help deliver exceptional patient care experiences! We value dedicated professionals who thrive in a collaborative environment focused on efficiency and compassion. Pay: $17.00 - $17.50 per hour Benefits: • Flexible schedule Experience: • medical authorization: 1 year (Preferred) Work Location: Remote Apply Now Apply Now