Insurance Prior AuthorizationsBilling Representative

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Profit sharing
• Vision insurance

Join our patient-centered healthcare team as a Prior Authorization/Billing Representative serving as the liaison between patients, providers and insurance companies. Daily responsibilities include verifying insurance coverage, obtaining approvals for procedures and patient account collections.

• Review, submit and track procedure authorization and pre-certification requests
• Communicate with insurance carriers via payer portals and phone to obtain approvals, authorizations, predeterminations and referrals as needed
• Follow up with insurnace companies, healthcare providers and patients to resolve and delays or issues in the authorization process
• Collaborate with clinical staff, procedure schedulers and revenue cycle team to resolve authorization issues or denials
• Support escalation of cases, including coordination of peer-to-peer reviews when required
• Communicate authorization approvals or denials to the appropriate provider, facility and patient
• Maintain detailed records of all authorization activiites in the electronic health record (EHR) system
• Stsy updated on changes in insurance policies, authorization guidelines and referral processes to ensure compliance
• Review daily provider office schedules to confirm patient's insurance is active and required referrals are in patient's chart
• Work closely with Billing Coordinate to monitor patient accounts and provide follow up support

• Familiarity with insurance plans, coverage policies and prior authorization requirements
• Proficient use of EHRs and payer portals
• Proficiency in medical terminology, ICD-10 and CPT coding
• Strong organizational, communication and problem-solving skills
• Ability to multitask and manage priorities in a fast-paced environment
• Attention to detail and accuracy in documentation and communication
  
  Knowledge of HIPAA regulations and patient confidentiality standards

• High school diploma or equivalent; associate degree or relevant certification in healthcare administration is a plus
• Minimum 1 - 2 years of experience in a healthcare setting with medical billing, insurance verification or authorization/referral experience
• Bilingual (Spanish) a plus
• eClinical
  
  Works EHR system experience a plus

This position is on-site for the first 30 days for orientation and training after which it becomes hybrid eligible based on performance and bisuness needs.

Flexible work from home options available.