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Pre-Authorization Specialist
2 months ago
The Bryan Health Pre-Authorization Specialist plays a crucial role in ensuring that patients receive the necessary medical services by verifying demographic and insurance information, obtaining prior authorization, and resolving any issues that may arise. This position requires strong problem-solving skills, attention to detail, and effective communication with patients, families, and healthcare providers.
Key Responsibilities- Verify Patient Information: Confirm patient demographic and insurance details to ensure accurate billing and authorization.
- Obtain Prior Authorization: Gather necessary information and present it to payer authorization representatives to secure approval for scheduled medical services.
- Collaborate with Business Office Team: Work closely with coders and billers to ensure accurate procedure and diagnosis codes are used in the pre-authorization process.
- Document Pre-Authorization Process: Accurately document all actions taken regarding pre-authorization, including tracking system updates.
- Stay Current with Payer Guidelines: Remain up-to-date with pre-authorization guidelines specific to all payers and inform staff and clinic administration as necessary.
- Provide Effective Communication: Communicate proactively and in response to patients, families, team members, physicians, and other healthcare providers while maintaining confidentiality.
- Establish Relationships with Community Resources: Develop and maintain relationships with cultural and community resources to assist patients experiencing financial difficulty or cost concerns.
- Attend Workshops and Training: Participate in workshops and training sessions to enhance pre-authorization skills and payer guidelines.
To be successful in this role, you will need:
- A High School diploma or equivalency
- Certified Medical Assistant or Licensed Practical Nurse preferred
- Minimum of one (1) year work experience in a medical office setting
- Prior pre-authorization, coding, or medical billing experience preferred
