Prior Authorization Specialist

6 days ago

Albuquerque, New Mexico, United States Southwest Women's Oncology Full time
Job Title: Prior Authorization Specialist

We are seeking a highly skilled Prior Authorization Specialist to join our team at Southwest Women's Oncology. As a Prior Authorization Specialist, you will play a critical role in ensuring that our patients receive the necessary pre-certifications and authorizations for services ordered.

Key Responsibilities:
  • Obtain pre-authorization from insurance carriers for medical services within a designated time frame.
  • Follow up and secure prior authorizations prior to service appointments.
  • Maintain a high level of understanding of insurance companies and billing authorization requirements.
  • Record all communication with providers and personnel in standardized documentation.
  • Review denial reasons and advocate for patients while obtaining approval/denial letters.
  • Build relationships with physician offices and clinics by initiating contact via email and responding promptly.
  • Contact insurance carriers to obtain benefit coverage and policy limitations.
  • Follow up with physicians, patients, and third-party payers to complete the pre-certification process.
  • Collaborate with Supervisor, internal departments, and clinical staff to provide account status updates and coordinate the resolution of issues.
  • Ensure information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements.
  • Educate patients, staff, and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, and insurance-related changes or trends.
Requirements:
  • 2-3 years of experience in healthcare with insurance and/or prior authorization experience.
  • Medical Billing Certificate or Certified Professional Coder certification desired.
Benefits:

We offer a comprehensive benefits package, competitive salary, and secure parking. Staff members have access to our performance center complete with a full AI gym suite, recovery modalities, group fitness classes, and body composition tracking.

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