MyOBGYN Centennial Hills Eligibility and Prior Authorization Specialist

Eligibility And Prior Authorization Specialist

Location: Las Vegas, NV Job Type: Full-Time

At Hera, we believe women's healthcare deserves higher standards where value is placed on the quality of care provided, and the best patient outcomes are achieved. We believe by focusing on data-driven and sustainable ways of optimizing outcomes within a culture that promotes evidence, collaboration and leadership we can and will achieve better healthcare for women and babies. My OBGYN, a Hera affiliate, is a medical practice in Las Vegas dedicated to providing exceptional patient care. We are committed to delivering high-quality healthcare services in a compassionate and efficient manner. As part of our team, you'll have the opportunity to contribute to improving the health and well-being of our community.

Position Overview

My OBGYN is seeking a detail-oriented and knowledgeable Eligibility and Prior Authorization Specialist to join our practice. The ideal candidate will be responsible for verifying patient benefits, obtaining prior authorizations for procedures and medications, and ensuring compliance with insurance guidelines.

Responsibilities:

• Verify patient insurance benefits and coverage for OBGYN services, including office visits, diagnostic tests, and surgical procedures.
• Obtain prior authorizations and pre-certifications for procedures, treatments, and medications as required by insurance providers.
• Communicate with insurance companies, patients, and healthcare providers to resolve any authorization or benefits-related issues.
• Maintain accurate records of authorizations, approvals, and denials in the electronic health record (EHR) system.
• Educate patients about their insurance benefits, coverage limitations, and out-of-pocket costs.
• Work closely with the billing department to address claim denials related to authorization issues.
• Stay up to date with insurance policies, coding changes, and payer requirements.
• Provide administrative support to the practice as needed, including scheduling and coordinating patient services.

Requirements:

• Minimum of 6 months' of experience in completing prior authorization for a medical facility; OBGYN or women's health setting PREFERRED
• Medical Assistance experience PREFERRED
• Strong understanding of insurance policies, prior authorization processes, and medical billing
• Proficiency in electronic health records (EHR) preferably AthenaOne
• Excellent communication and customer service skills
• Strong attention to detail and ability to work efficiently in a fast-paced environment

Benefits:

• Medical insurance
• Dental insurance
• Vision insurance
• 401k with company match
• Company-paid Life insurance
• Paid Time Off/Paid holidays