Prior Authorization and Scheduling Representative

Job Description

Job Description

Prior Authorization and Scheduling Representative

(Onsite Position, Not Remote)

Tulsa, OK

Monday-Friday | 8:00 AM - 5:00 PM

Pay: $17-$19/HR DOE

A growing healthcare team in Tulsa is seeking a detail oriented and motivated Prior Authorization and Scheduling Representative to join their office. This position plays a key role in coordinating patient care by obtaining insurance authorizations, verifying benefits, and scheduling specialized studies. The ideal candidate will have prior medical office experience, strong analytical skills, and the ability to manage multiple tasks in a fast paced environment.

Responsibilities:

• Obtain prior authorizations for special studies through multiple insurance carriers using payer specific tools and systems

• Maintain current knowledge of insurance pre certification requirements and authorization processes

• Review and interpret clinical information related to authorization requests

• Cross reference medical terminology, diagnosis codes, and CPT codes for insurance compliance

• Verify patient eligibility and benefits prior to scheduling services

• Coordinate and schedule appointments for special studies and procedures

• Communicate with patients, providers, and clinical staff regarding scheduling and authorization updates

• Accurately document referrals, authorizations, scheduling details, and patient information in the practice management system

• Ensure all documentation is completed thoroughly and accurately

Must Haves:

• Previous medical office experience

• Experience with prior authorizations and insurance verification

• Knowledge of medical terminology, CPT codes, and diagnosis codes

• Strong attention to detail and organizational skills

• Excellent communication and customer service abilities

• Ability to multitask and manage a high volume workload

• Experience using EMR/EHR or practice management software

• Strong analytical and problem solving skills

Nice to Haves:

• Experience scheduling special studies or procedures

• Familiarity with multiple insurance carrier portals and payer websites

• Experience working in a specialty clinic environment

• Understanding of referrals and pre certification processes

• Stable work history in healthcare administration

• Bilingual abilities

• Strong computer and data entry skills

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* Determine eligibility of persons applying to receive assistance from government programs and agency resources, such as welfare, unemployment benefits, social security, and public housing.

* Interpret and explain information such as eligibility requirements, application details, payment methods, and applicants' legal rights.

* Keep records of assigned cases, and prepare required reports.

* Interview benefits recipients at specified intervals to certify their eligibility for continuing benefits.

* Compile, record, and evaluate personal and financial data to verify completeness and accuracy, and to determine eligibility status.

* Answer applicants' questions about benefits and claim procedures.

* Compute and authorize amounts of assistance for programs, such as grants, monetary payments, and food stamps.

* Provide social workers with pertinent information gathered during applicant interviews.

* Provide applicants with assistance in completing application forms, such as those for job referrals or unemployment compensation claims.

* Prepare applications and forms for applicants for such purposes as school enrollment, employment, and medical services.

* Monitor the payments of benefits throughout the duration of a claim.

* Refer applicants to job openings or to interviews with other staff, in accordance with administrative guidelines or office procedures.

* Schedule benefits claimants for adjudication interviews to address questions of eligibility.

* Check with employers or other references to verify answers and obtain further information.

* Initiate procedures to grant, modify, deny, or terminate assistance, or refer applicants to other agencies for assistance.