Prior Authorization Representative

Prior Authorization Representative Job Description

Client Profile An Indiana based Independent PhysicianOwned radiology practices founded in 1967.

Job Summary Prior Authorization Representative is responsible for securing inpatient/outpatient accounts by performing insurance verification obtaining benefit information calculating patient estimates and obtaining prior authorizations before service are rendered. Must be comfortable working with clinical professionals.

Job Duties

• Verify insurance eligibility benefits network status and create preservice liability estimate.
  

• Ensure accurate ICD CPT codes and related medical records are submitted in the authorization request.
  

• Secure prior authorizations of inpatient and outpatient imaging.
  

• Acts as a liaison between the payer and clinic schedulers/medical support.
  

• Follows up on delayed or denied authorizations requests and escalates for resolution.
  

• Create detail documentation and maintain/stores the authorization paper trail.
  

Qualifications

• High School Diploma 3years of experience in a health care financial setting or medical office setting. Must have previous prior authorization experience.
  

• Excellent customer service skills strong attention to details multitask as needed.
  

• Must be familiar with an EMR or HER; Microsoft Office 365
  

• Must be able to take responsibility and work under pressure. Work efficiently in a busy medical office.
  

• Must be a positive team player.
  

• Knowledge of ICD10 CPT and HCPCS codes specific to radiology is a plus.
  

• Proficient in medical terminology especially radiological terms and procedures.
  

• Days/Hours: M/F 8a to 5pm (Availability to start as early as 7a and work as last as 6:00pm is a plus)
  

• Starting pay $20.00 to $21.00 hourly (Based on experience)