Prior Authorization/Pre Certification Specialist

We are looking for a dedicated Prior Authorization/Pre Certification Specialist to join our team. In this role, you will be responsible for obtaining necessary authorizations and pre-certifications for a variety of medical services. The ideal candidate will have a strong understanding of insurance processes and the ability to effectively communicate with healthcare providers and insurance companies.

Key Responsibilities

• Initiate and manage the authorization process for inpatient and outpatient services.
• Verify patient insurance benefits and eligibility for procedures and treatments.
• Collaborate with physicians and clinical staff to obtain supporting medical documentation for authorizations.
• Communicate effectively with patients regarding their insurance coverage and authorization status.
• Maintain accurate records of all authorizations, denials, and appeals.
• Follow up on pending authorizations and address any issues that arise during the process.

Requirements

• Previous experience as a Prior Authorization Specialist or similar role in a US healthcare setting is required.
• Strong knowledge of insurance verification processes and medical billing.
• Excellent communication skills to facilitate interactions with patients, providers, and insurers.
• Highly detail-oriented with strong organizational and time management skills.
• Proficiency with electronic health record (EHR) systems and Microsoft Office applications.
• Ability to work independently and stay focused in a fast-paced environment.