Insurance Prior Authorizations/Billing Representative

Job Description

Job Description

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 insurance 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 activities in the electronic health record (EHR) system
• Stay 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

Required Skills/Abilities:

• 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

Education/Experience and Other:

• 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
• eClinicalWorks EHR system experience a plus

This position is on-site for the first 30 days for orientation and training then remote one to two days per week.