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Patient Accounts Pre-Authorization Specialist

2 months ago

Rockford, United States Rockford Gastroenterology, Assc., LTD Full time
Job DescriptionJob DescriptionDescription:

Overall Summary:

RGA is seeking a detail-oriented and experienced Prior Authorization Specialist to join our team. In this role, you will be responsible for obtaining prior authorizations from insurance companies for medical procedures, medications, and services to ensure timely and accurate reimbursement for our patients.

Key Responsibilities:


o Prior Authorization Process:


  • Review patient medical records and treatment plans to determine the need for prior authorizations.
  • Initiate and complete prior authorization requests with insurance companies via phone, online portals, and written correspondence.
  • Gather necessary documentation, such as medical reports, test results, and prescription details, to support authorization requests.


o Insurance Verification:


  • Verify patients' insurance coverage and benefits for specific procedures or services requiring prior authorization.
  • Communicate coverage details, copayments, deductibles, and out-of-pocket costs to patients and healthcare providers.


o Follow-up and Appeals:


  • Monitor the status of prior authorization requests and follow up with insurance companies as needed to expedite approvals.
  • Coordinate with healthcare providers to address any additional information or appeals required for denied authorizations.
  • Document all communication and actions related to prior authorizations in the electronic health records (EHR) system.


o Compliance and Documentation:


  • Ensure compliance with insurance guidelines, regulatory requirements, and billing policies during the prior authorization process.
  • Maintain accurate records of authorization numbers, approval dates, and authorization periods for billing and reimbursement purposes.
  • Assist with coding and billing tasks related to authorized services and procedures.

Other Duties assigned by Manager

Requirements:

Qualifications:


  • High school diploma or equivalent; associate or bachelor's degree in healthcare administration or related field preferred.
  • Minimum of 2 years of prior authorization experience in a medical setting, preferably in a hospital or clinic.
  • Knowledge of medical terminology, CPT/HCPCS codes, and insurance billing procedures.
  • Familiarity with electronic health records (EHR) systems and insurance verification tools.
  • Strong communication skills with the ability to interact professionally with patients, healthcare providers, and insurance representatives.
  • Excellent organizational skills and attention to detail to ensure accuracy in documentation and follow-up.
  • Ability to prioritize tasks, work independently, and meet deadlines in a fast-paced environment.
  • Understanding of HIPAA regulations and patient confidentiality.


Key Competencies:


  • Problem-solving skills to identify root causes of claim denials.
  • Ability to prioritize tasks and manage multiple appeals simultaneously.
  • Team player with a collaborative approach to work.
  • Adaptability to changing insurance policies and billing requirements.
  • Strong organizational skills to maintain detailed appeal records.