Insurance Prior Authorizations/Billing Representative

Job DescriptionJob DescriptionBenefits:401(k)401(k) matchingDental insuranceHealth insurancePaid time offProfit sharingVision insurance Join our patient-centered healthcare team as a Prior Authorization/Billing Representative serving as the liaison between patients, providers and insurance companies. Daily responsibilities include verifying insurance coverage, obtaining approvals for procedures and patient account collections.Duties/Responsibilities:Review, submit and track procedure authorization and pre-certification requestsCommunicate with insurance carriers via payer portals and phone to obtain approvals, authorizations, predeterminations and referrals as neededFollow up with insurnace companies, healthcare providers and patients to resolve and delays or issues in the authorization processCollaborate with clinical staff, procedure schedulers and revenue cycle team to resolve authorization issues or denialsSupport escalation of cases, including coordination of peer-to-peer reviews when requiredCommunicate authorization approvals or denials to the appropriate provider, facility and patientMaintain detailed records of all authorization activiites in the electronic health record (EHR) systemStsy updated on changes in insurance policies, authorization guidelines and referral processes to ensure complianceReview daily provider office schedules to confirm patient's insurance is active and required referrals are in patient's chart Work closely with Billing Coordinate to monitor patient accounts and provide follow up supportRequired Skills/Abilities:Familiarity with insurance plans, coverage policies and prior authorization requirementsProficient use of EHRs and payer portalsProficiency in medical terminology, ICD-10 and CPT codingStrong organizational, communication and problem-solving skillsAbility to multitask and manage priorities in a fast-paced environmentAttention to detail and accuracy in documentation and communicationKnowledge of HIPAA regulations and patient confidentiality standardsEducation/Experience and Other:High school diploma or equivalent; associate degree or relevant certification in healthcare administration is a plusMinimum 1 - 2 years of experience in a healthcare setting with medical billing, insurance verification or authorization/referral experienceBilingual (Spanish) a pluseClinicalWorks EHR system experience a plusThis position is on-site for the first 30 days for orientation and training after which it becomes hybrid eligible based on performance and bisuness needs.Flexible work from home options available.

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