Prior Authorization Coordinator

1 week ago


Atlanta, Georgia, United States The Leaders Rheum Full time
Prior Authorization Specialist Job Description

The Leaders Rheum is seeking a skilled Prior Authorization Specialist to join our team in Atlanta, GA.

The Prior Authorization Specialist plays a crucial role in ensuring that medical services, treatments, and medications are covered by insurance plans. This involves reviewing medical records, communicating with insurance companies, and working with healthcare providers to obtain necessary approvals.

Key Responsibilities:
  • Review and process prior authorization requests submitted by healthcare providers.
  • Verify patient eligibility and benefits, and determine coverage based on insurance policies.
  • Gather and submit all required documentation, including medical records, treatment plans, and additional information as needed.
  • Ensure compliance with insurance company guidelines and company policies.
  • Act as a liaison between healthcare providers, insurance companies, and patients to facilitate the authorization process.
  • Communicate clearly and effectively to gather information, address concerns, and resolve issues.
  • Address and resolve issues related to denied or pending authorizations.
  • Provide solutions or alternatives when necessary and follow up to ensure issues are resolved.
  • Track the status of pending authorizations and ensure timely processing.
Requirements:
  • 1 year or more in a healthcare environment.
  • Associate degree or any combination of education and work experience in a customer service-related role.
  • Experience with Medical terminology.
Why You Should Apply:

The Leaders Rheum offers a collaborative, team-oriented work environment and a competitive benefits package that includes group medical, dental, vision, short-term & long-term disability insurance, paid holidays, Paid time off, and 401K.



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