Description Our client is seeking a detail-oriented and proactive individual to join their team as a Prior Authorization Specialist. The Prior Authorization Specialist will play a crucial role in obtaining pre-authorizations from insurance companies for medical procedures, treatments, and medications, ensuring timely access to necessary healthcare services for our patients.Responsibilities:
Review patient medical records and treatment plans to determine the need for prior authorizations.
Communicate with healthcare providers to gather necessary clinical information and documentation for authorization requests.
Verify patient insurance coverage and eligibility, including understanding plan-specific requirements for prior authorizations.
Submit prior authorization requests to insurance companies through various channels, including online portals, fax, and phone.
Follow up on pending authorization requests, providing additional information or documentation as requested by insurance companies.
Monitor the status of authorization requests, documenting outcomes and ensuring timely resolution.
Communicate authorization decisions to healthcare providers, patients, and other relevant parties.
Collaborate with internal teams, including physicians, nurses, and billing staff, to ensure compliance with authorization requirements and minimize delays in patient care.
Stay informed about changes in insurance policies, regulations, and procedures related to prior authorizations.
Requirements
Qualifications:
High school diploma or equivalent; associate or bachelor's degree preferred.
Previous experience in prior authorization, healthcare insurance verification, or related field preferred.
Strong understanding of medical terminology, procedures, and diagnostic codes (CPT, ICD-10).
Excellent communication and interpersonal skills, with the ability to interact professionally with patients, providers, and insurance representatives.
Detail-oriented approach with strong analytical and problem-solving abilities.
Proficiency in computer applications, including electronic health records (EHR) systems and Microsoft Office suite.
Ability to work independently and collaboratively in a team environment.
Knowledge of insurance regulations, reimbursement policies, and prior authorization guidelines.
Commitment to maintaining patient confidentiality and adhering to HIPAA regulations.
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https:///www.roberthalf.com/us/en/terms) .
