Prior Authorization Specialist - Electronic Medical Records

Job Description

Job Description

Join Our Team as a Prior Authorization Specialist!

Are you a compassionate and patient-focused Prior Authorization Specialist seeking a rewarding and challenging opportunity? Eagle Physicians & Associates is seeking a dynamic, self-motivated Prior Authorization Specialist to join our Eagle Medical Record Team.

We offer a competitive salary, a collaborative work environment, and an outstanding benefits package designed to support both your personal and professional growth.

Schedule

• Monday–Friday
• 8:00 AM–5:00 PM
• Shift hours may vary based on the needs of the practice as determined by the manager.
• After training period, this may become a hybrid role.

Qualifications (Preferred but not required)

• Medical Assistant
• Licensed LPN
• 3+ years of medical office experience

Why Eagle?

Our employees genuinely enjoy working at Eagle. For three consecutive years, Eagle team members have rated the organization highly in our annual Employee Engagement Surveys. In our most recent survey, 92.8% of employees shared that they see themselves continuing their career at Eagle and would recommend Eagle as a great place to work.

Join Us and Thrive!

Support staff hired at a 0.50 FTE or greater on or after April 1, 2024, are eligible for our structured retention bonus program:

• $750 at 6 months
• $750 at 12 months
• $1,000 at 18 months
• $1,000 at 24 months

Paid Maternity/Paternity Leave

After one year of employment and 1,250 hours worked, Eagle provides up to two weeks of paid maternity/paternity leave for the birth or adoption of a child. Leave is prorated based on FTE status.

Influenza Vaccine Requirement

As a condition of employment, an influenza vaccine is required. Please contact Eagle HR with any questions regarding this policy.

Eagle Physicians & Associates is proud to be an Equal Opportunity Employer.

Key Responsibilities

• Process prior authorization requests received by fax, phone, electronic portals, or other approved methods.
• Review patient medical records and supporting clinical documentation to determine authorization requirements.
• Verify patient insurance eligibility, benefits, and prior authorization requirements with insurance carriers.
• Prepare, complete, and submit prior authorization requests with accurate clinical documentation.
• Monitor authorization requests, follow up on pending or denied cases, and provide additional information as needed to facilitate approval.
• Document authorization determinations, communicate approval or denial to patients and pharmacies, and ensure authorization information is accurately recorded in the medical record.
• Maintain complete, accurate, and standardized documentation of all communications with patients, providers, insurance carriers, pharmacies, and other healthcare personnel.
• Obtain signed medical releases and other required patient documentation in accordance with organizational policies.
• Maintain organized work areas, restock supplies as needed, and follow established safety protocols, including the appropriate use of personal protective equipment (PPE).
• Protect patient confidentiality by complying with HIPAA regulations and safeguarding Protected Health Information (PHI) and confidential business information.
• Demonstrate professionalism, compassion, and excellent customer service when interacting with patients, visitors, providers, coworkers, pharmacies, and insurance representatives.
• Participate in staff meetings, committees, continuing education, and professional development activities to support ongoing growth and organizational initiatives.
• Support a collaborative, team-oriented work environment by assisting colleagues and contributing to departmental success.
• Uphold Eagle Physicians' Vision, Mission, Values, and Diversity, Equity, and Inclusion (DEI) principles through daily interactions and decision-making.
• Perform other duties and responsibilities as assigned.

• Knowledge of medical terminology, healthcare operations, insurance verification, and prior authorization processes.
• Knowledge of medical office procedures, clinical documentation, and applicable healthcare regulations.
• Understanding of HIPAA requirements and the proper handling of Protected Health Information (PHI).
• Ability to interpret insurance benefits, payer requirements, and medical necessity guidelines.
• Strong organizational skills with the ability to manage multiple priorities and meet deadlines.
• Excellent verbal and written communication skills with the ability to interact professionally with patients, providers, pharmacies, insurance carriers, and coworkers.
• Strong attention to detail and accuracy in documentation, data entry, and record maintenance.
• Proficiency in electronic medical records (EMR/EHR), insurance portals, and standard office software.
• Ability to maintain effective working relationships while providing exceptional customer service.
• Ability to exercise sound judgment, maintain confidentiality, and work independently in a fast-paced healthcare environment.