Insurance Prior AuthorizationsBilling Representative

Benefits:

401(k)

401(k) matching

Dental insurance

Health insurance

Paid time off

Profit sharing

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.

Duties/Responsibilities:

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.

Flexible work from home options available.