Deskripsi Pekerjaan
Join our dynamic healthcare team as a Prior Authorization Specialist, where you'll play a critical role in ensuring seamless patient care through efficient insurance approval processes. This position requires meticulous attention to detail and strong communication skills to coordinate between healthcare providers, insurance companies, and clinical teams. You'll be responsible for reviewing medical documentation, verifying insurance coverage, and advocating for timely approvals that directly impact patient treatment timelines. Our ideal candidate thrives in fast-paced environments and is committed to reducing administrative burdens for both patients and healthcare providers while maintaining compliance with industry regulations and organizational protocols.
Tanggung Jawab
- Review and process prior authorization requests for medical treatments, procedures, and medications
- Liaise directly with insurance companies to verify coverage, gather requirements, and expedite approvals
- Collaborate with clinical teams to collect complete medical documentation and supporting evidence
- Track authorization statuses proactively and resolve denials through effective follow-up
- Maintain accurate records in electronic health records (EHR) and authorization systems
- Ensure compliance with HIPAA, PHI regulations, and company policies
- Provide timely updates to patients and providers regarding authorization statuses
- Identify process improvement opportunities to reduce approval turnaround times
Kualifikasi
- Bachelor's degree in Healthcare Administration, Nursing, or related field (or equivalent experience)
- Minimum 2 years' experience in healthcare insurance or prior authorization roles
- Proficiency in medical terminology, CPT/ICD-10 coding, and insurance protocols
- Advanced communication skills for effective stakeholder negotiations
- Experience with EHR systems and prior authorization software (e.g., Availity, Change Healthcare)
- Strong analytical and problem-solving abilities for complex cases
- Detail-oriented with exceptional organizational and time-management skills
- Professional certification (e.g., CPAM, CPCS) preferred