Pre-Authorization Specialist at Georgia Eye Institute of the Southeast LLC

, Georgia, United States -

Full Time

Start Date

Immediate

Expiry Date

09 Jan, 26

Salary

0.0

Posted On

11 Oct, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Attention To Detail, Organizational Skills, Communication Skills, Problem-Solving, Teamwork, Medical Terminology, ICD-10 Coding, CPT Coding, Insurance Verification, Practice Management Software, Electronic Health Records, Microsoft Office

Industry

Medical Practices

Description

Description The Pre-Authorization Specialist is responsible for ensuring that all medical services requiring pre-authorization are approved by insurance providers before patient appointments or treatments. This role involves working closely with healthcare providers, insurance companies, and patients to confirm that all required pre-certifications and authorizations are obtained efficiently. The specialist will play a key role in minimizing delays in patient care, reducing claim denials, and ensuring compliance with insurance policies and procedures. Key Responsibilities: 1. Authorization and Verification: Obtain prior authorizations for required medical procedures, diagnostic tests, surgeries, medications, and treatments. Verify patient insurance coverage and eligibility for scheduled services. Submit necessary documentation and clinical information to insurance companies to facilitate approval of services. 2. Communication and Coordination: Communicate effectively with insurance providers, medical staff, and patients regarding authorization status, requirements, and any issues that may impact treatment. Collaborate with healthcare providers to gather additional information needed for authorization approvals. Educate patients on their coverage details, out-of-pocket responsibilities, and any prior authorization requirements. 3. Documentation and Tracking: Maintain accurate records of authorization status, approvals, denials, and any related communications. Track and follow up on pending authorizations to ensure timely responses and avoid delays in patient care. Document all actions taken in patient records and keep detailed logs for audit and billing purposes. 4. Insurance and Denial Management: Assist with addressing denied authorizations by gathering additional information or resubmitting requests as needed. Work with billing and claims departments to resolve pre-authorization issues that result in claim denials. Monitor trends in authorization denials to identify and communicate areas for improvement. 5. Compliance and Policy Adherence: Stay up-to-date on insurance company policies, state and federal healthcare regulations, and pre-authorization requirements. Adhere to all HIPAA regulations and ensure patient confidentiality throughout the pre-authorization process. Participate in training and quality assurance programs to maintain a high standard of work. Requirements Qualifications: Education: High school diploma or GED required; associate degree in finance, accounting, or healthcare administration preferred. Experience: 1-2 years of experience in healthcare pre-authorization, billing, or insurance verification, preferably in a medical office or hospital setting. Technical Skills: Proficiency in practice management software, electronic health records (EHR), and Microsoft Office (Excel, Word, Outlook and Teams). Knowledge: Strong understanding of medical terminology, ICD-10 and CPT coding, and insurance industry practices. Attention to Detail: Exceptional attention to detail and accuracy in financial analysis and data entry. Organizational Skills: Strong organizational and time management skills with the ability to handle multiple tasks and prioritize effectively. Communication Skills: Excellent verbal and written communication skills, with the ability to communicate clearly with patients, staff, and external parties. Problem-Solving: Strong analytical and problem-solving skills, with the ability to identify and resolve discrepancies in patient accounts. Teamwork: Ability to work collaboratively with other departments and contribute to a positive team environment. Work Environment: Office Setting: This position typically works in an office setting with standard hours. Remote Work: We do offer a hybrid schedule if interested. Physical Requirements: Ability to sit for extended periods, use a computer, and perform repetitive tasks. Compensation and Benefits: Competitive salary based on experience. Comprehensive benefits package, including health and dental insurance. Paid time off (PTO). Opportunities for professional development and advancement.

Responsibilities

The Pre-Authorization Specialist ensures that all medical services requiring pre-authorization are approved by insurance providers before patient appointments or treatments. This role involves working closely with healthcare providers, insurance companies, and patients to confirm that all required pre-certifications and authorizations are obtained efficiently.