Prior Authorization Representative

Prior Authorization Representative

At Clinical Associates, we make being healthy easier. As a premier multi-specialty physicians' practice located in the Towson, Pikesville, and Reisterstown communities, we connect our patients to a seamless system of integrated medical care. Our practice includes in-house specialists in areas of medicine, from cardiology to podiatry. We also offer unique services like our nuclear stress testing facility.

We are seeking to add an experienced and detail-oriented Prior Authorization Representative to our Cardiology team! Our ideal candidate will possess 1-2 years of experience in a healthcare setting with solid working knowledge of insurance verification & eligibility along with obtaining prior authorizations for office procedures and diagnostic testing. The candidate must be a team player and provide excellent customer service to our patients.

Shift Hours: Full Time / Monday Friday 8:30 am 4:30 pm

Location: Towson - 515 Fairmount Avenue or Pikesville 1838 Greene Tree Road

This is an in-person onsite position. No hybrid or remote work options are available.

Job Duties include but are not limited to the following:

• Runs appointment lists and verifies insurance coverage along with identifying which patients need prior authorizations for scheduled appointments, procedures, and diagnostic testing.
• Completes the prior authorization process 2 weeks prior to the scheduled appointments.
• Contacts patients to inform them of their financial out-of-pocket costs: co-pay, deductible, and co-insurance amounts.
• Confirms if referrals have been received prior to scheduled appointments.
• Contacts primary care providers or other healthcare facilities as needed to obtain referrals or missing information for office visits or procedures.
• Contacts insurance companies to confirm continued coverage or to resolve billing issues, discrepancies, or denials.
• Accurately enters and updates patient demographics, insurance information, and authorization and referral tracking into the EMR system.
• Schedules appointments
• Other duties as assigned to support the overall workflow efficiency of the department.

Minimum Qualifications:

• High School Diploma or equivalent
• Medical office or health care experience is required. Specialty medicine and/or Cardiology are a plus.
• 1-2 years of proven experience in healthcare insurance verification / prior authorization or billing is required.
• Strong attention to detail and organizational skills.
• Strong time management skills.
• Knowledge and understanding of CPT/ICD 10 coding and billing protocols.
• Experience with EPM/EMR - specifically NextGen is a plus.
• Excellent verbal communication skills with ability to hear and to speak standard English clearly and concisely.
• Excellent written communication skills with ability to read, write and spell standard English clearly and concisely.
• Ability to interact effectively with culturally diverse patients, practitioners, and employee population.
• Ability to convey a positive attitude and project a professional image.
• Ability to remain flexible and maintain confidentiality.
• Possesses excellent time management skills.
• Requires lengthy periods of sitting, intermittent standing, reaching, and bending.

Benefits:

• Paid Time Off
• Medical
• Vision
• Dental
• Life Insurance
• Paid Holidays
• 401K(matching)

Clinical Associates is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.