Patient Account Representative - Diagnostic Pre-Authorization

Job Description

Job Description

We are seeking Healthcare Prior Authorization Specialists to support diagnostic, outpatient, procedural, therapy, imaging, infusion, surgery, and other healthcare services. This role is responsible for determining when prior authorization, referrals, pre-certification, or payer review is required and ensuring requests are submitted accurately and within required timelines.

The ideal candidate has at least 1 year of healthcare revenue cycle, insurance verification, prior authorization, billing, denials, or insurance follow-up experience and is comfortable working in a production-based environment.

Overview of Responsibilities:

• Review scheduled encounters to determine prior authorization, referral, pre-certification, or notification requirements.
• Verify patient eligibility, coverage, plan details, and payer requirements.
• Review CPT/HCPCS codes, diagnosis codes, providers, facility, date of service, units, and other authorization details.
• Submit prior authorization/PAR requests through payer portals, phone, fax, or electronic systems.
• Gather and submit required clinical documentation, orders, notes, test results, and payer forms.
• Track pending requests and follow up with payers through final determination.
• Document authorization activity, reference numbers, approval details, denials, and next steps.
• Escalate cases at risk for delays, cancellations, missed deadlines, or denials.
• Communicate with Scheduling, Patient Access, clinical teams, and financial clearance.
• Meet productivity, quality, accuracy, and turnaround-time expectations.

Minimum Qualifications:

• High school diploma/GED.
• 1+ year of healthcare experience in prior authorization, insurance verification, revenue cycle, billing, denials, or insurance follow-up. (Experience must be recent, within the last year).
• Knowledge of commercial, Medicare, Medicaid, and managed-care payer requirements.
• Strong attention to detail and ability to work independently in a production-based environment.
• Proficiency with Microsoft Office.

Preferred Qualifications:

• Experience with diagnostic/imaging, outpatient, surgery, infusion, or procedural authorizations.
• Epic, Cerner, Meditech, payer portal, or clearinghouse experience.
• Experience with insurance A/R, denials, claims follow-up, or appeals.

Schedule: 8-hour shift Monday-Friday between 8AM-8PM CST (40 hour work week)

Pay: $20-23 per hour depending on experience

Equipment Security Deposit Program: $30 will be set aside from each paycheck for the first 10 weeks of employment for a total of $300. The full amount will be returned to you upon receipt of the equipment or upon permanent employment.

Length: 800 hours (Approx. 5 months) Contract Opportunity (Possibility of extension or permanent employment).

Medical/Dental/Vision Benefits & Paid Sick Time offered by Medix.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?