Medical Authorization Specialist

1 day ago


Houston, Texas, United States Premier Medical Resources Full time
Premier Medical Resources Job Description

We are seeking a highly skilled and detail-oriented Prior Authorization Specialist to join our team at Premier Medical Resources. As a key member of our healthcare management company, you will play a critical role in ensuring the smooth operation of our pre-authorization processes.

Key Responsibilities:
  • Prioritize and manage incoming authorization requests to ensure timely and accurate processing.
  • Verify and oversee the complete procedure authorization/referral process to ensure compliance with medical policies and guidelines.
  • Monitor provider network status and notify relevant parties of non-network providers.
  • Obtain and follow up on pending authorizations to ensure seamless communication with payers and providers.
  • Initiate and assist with appeals for denied authorizations to ensure optimal patient outcomes.
  • Effectively maintain and update payer medical policy guidelines to stay current with changing regulations and guidelines.
Requirements:
  • High school diploma or equivalent with a minimum of two years of experience in a medical office or facility setting.
  • Knowledge of ICD-10 and CPT codes and procedures, as well as medical necessity requirements.
  • Excellent communication and organizational skills to effectively manage multiple tasks and priorities.
  • Ability to work independently and as part of a team to achieve common goals and objectives.
Benefits:
  • Competitive salary and benefits package including medical, dental, and vision plans.
  • 401(k) plan with a 2-year vesting period to support long-term financial goals.
  • PTO and holiday time off to ensure work-life balance.

Please visit our website for more information on our company culture and benefits package. Compensation will be determined based on education, experience, and internal equity.



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