Prior Authorization Coordinator

3 days ago


Philadelphia, Pennsylvania, United States Spectrum Health Services, Inc Full time
Job Summary

Spectrum Health Services, Inc is seeking a skilled Prior Authorization Specialist to join our team. As a vital member of our healthcare team, you will be responsible for managing the pre-approval process for patient treatments and medications with insurance companies.

Key Responsibilities
  • Review and Interpret Physician Orders: Assess the necessity and accuracy of prior authorization requests by reviewing physician orders and patient medical records.
  • Verify Patient Coverage: Contact insurance providers to verify patient coverage and benefits for prescribed medications and treatments.
  • Submit Authorization Requests: Submit authorization requests through electronic health records (EHR) systems, online portals, or via telephone.
  • Collaborate with Healthcare Providers: Work with healthcare providers to gather additional information or clarification needed for prior authorization submissions.
  • Monitor and Track Authorizations: Monitor and track the status of submitted authorizations, following up as necessary to resolve delays or issues.
  • Communicate with Patients: Communicate effectively with patients regarding the status of their authorization, including any additional information or action required on their part.
  • Ensure Regulatory Compliance: Adhere to healthcare regulations, including HIPAA, to ensure patient privacy and confidentiality of medical information.
Requirements
  • Medical Billing Software Proficiency: Proficiency in medical billing software and electronic health records systems.
  • Medical Terminology Knowledge: Familiarity with medical terminology and understanding of ICD-10 and CPT codes.
  • Organizational Skills: Strong organizational skills and the ability to prioritize tasks in a fast-paced environment.
  • Communication Skills: Excellent communication and customer service skills, with an empathetic regard for patient needs.
  • Experience: A minimum of two years' experience in a medical business office or healthcare setting involving customer service or patient-facing responsibilities.
Benefits
  • Medical, Vision, and Dental Insurance
  • Paid Time Off
  • Sick Time
  • 403B Plan

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