Customer Service / Prior Authorization Representative

Gryphon-Healthcare; Houston (TX); On-site; USD 42,000 - 64,000; Full time

Job summary

Gryphon-Healthcare in Houston, TX is seeking a motivated Customer Service / Prior Authorization Representative to serve as the first contact for patients and manage insurance prior authorizations to ensure timely access to care. The ideal candidate has at least 1 year of prior authorization experience in a medical setting, with radiology PA experience strongly preferred.

You will verify benefits, coordinate with providers and insurers, and support the Medical Records Department while delivering

Qualifications

• Prior authorization experience in a medical setting is required.
• Radiology prior authorization experience strongly preferred.
• Experience with medical insurance verification.
• Knowledge of commercial insurance plans, Medicare, and Medicaid.
• Ability to interpret Explanation of Benefits (EOBs).
• Excellent data entry and attention to detail.
• Strong communication and customer service skills.
• Bilingual English/Spanish is a plus but not required.

Responsibilities

• Answer patient and provider inquiries by phone or email.
• Obtain, submit, monitor, and document insurance prior authorizations for medical services.
• Verify insurance eligibility and benefits.
• Process patient payments and generate statements.
• Assist the Medical Records Department with requests for records.

Skills

Prior authorization

Radiology PA

Insurance verification

EOB interpretation

Attention to detail

Communication skills

Call center experience

Bilingual EN/ES

Education

High School Diploma or equivalent

Tools

EMR/EHR systems

EDI

Insurance portals

Job description

Position:Customer Service / Prior Authorization Representative

Location: Houston, TX

Remote Status: On-Site

Customer Service / Prior Authorization Representative

We are seeking an enthusiastic and detail-oriented Customer Service / Prior Authorization Representative to join our team. In this role, you will serve as the first point of contact for our patients while also managing prior authorization requests to help ensure timely access to care.

The ideal candidate will have prior authorization experience in a medical setting, with Radiology experience strongly preferred. You will work closely with our client medical offices, insurance carriers, and internal teams to obtain authorizations, verify benefits, resolve patient inquiries, and support the Medical Records Department.

The Ideal Candidate Will Have:

• Previous prior authorization experience is required – Minimal 1 year experience required
• Radiology prior authorization experience is strongly preferred
• Experience with medical insurance verification
• Knowledge of commercial insurance plans, Medicare, and Medicaid
• Ability to interpret Explanation of Benefits (EOBs)
• Strong attention to detail and accurate data entry skills
• Excellent communication and customer service skills
• Previous call center or high-volume patient service experience
• A passion for helping patients and providing exceptional customer service

Job Description – Customer Service / Prior Authorization Representative

Location: Houston, TX 77041

Job Summary

The Customer Service / Prior Authorization Representative is responsible for responding to patient account inquiries, obtaining and managing insurance prior authorizations, verifying insurance eligibility and benefits, processing patient payments, generating patient statements, and assisting with medical records requests. This position works closely with providers, insurance companies, and patients to ensure services are authorized and patient billing questions are resolved accurately and efficiently.

Duties and Responsibilities

• Answer incoming calls from patients and customers, identifying the type of assistance needed.
• Obtain, submit, monitor, and document insurance prior authorizations for medical services and procedures.
• Verify insurance eligibility, benefits, authorization requirements, and referral requirements.
• Follow up with insurance carriers regarding pending or denied authorizations and appeals as appropriate.
• Coordinate with physician offices, scheduling staff, and clinical personnel to obtain required documentation for authorization requests.
• Ask appropriate questions and actively listen to identify customer concerns while accurately documenting information in company systems.
• Research patient accounts and healthcare claims using multiple computer systems.
• Ensure appropriate insurance benefits are applied to each patient account.
• Process patient payments and generate patient statements.
• Assist the Medical Records Department by retrieving records for patients, attorneys, and third-party vendors.
• Meet established performance goals for quality, productivity, customer satisfaction, accuracy, and attendance.
• Demonstrate excellence in customer service with every patient interaction.
• Participate in continuing education to remain current on medical billing, insurance regulations, and prior authorization requirements.
• Support other members of the Revenue Cycle team as needed.
• Perform other duties as assigned.
• Customer Service
• Problem Solving
• Analytical Thinking
• Attention to Detail
• Technical Skills
• Oral Communication
• Teamwork
• Organization and Time Management
• Ethics and Confidentiality

Education Requirements

• High School Diploma or equivalent required.

Experience Requirements

• Minimum of one (1) year of customer service experience in a medical office, clinic, hospital, emergency room, or healthcare setting.
• Minimum of one (1) year of prior authorization experience required.
• Radiology prior authorization experience strongly preferred.
• Medical billing and insurance verification experience preferred.

Special Knowledge, Skills, and Abilities Required

• Knowledge of insurance prior authorization processes and payer requirements.
• Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans.
• Knowledge of medical billing and collection practices.
• Ability to interpret Explanation of Benefits (EOBs).
• Familiarity with EMR/EHR systems, EDI, and insurance portals.
• Understanding of HIPAA regulations and patient confidentiality requirements.
• Strong organizational, follow-up, and time management skills.
• Excellent verbal and written communication skills.
• Ability to multitask and prioritize in a fast-paced environment.
• Detail-oriented with accurate data entry skills.
• Proficiency with Microsoft Outlook and Windows-based computer systems.
• Bilingual (English/Spanish) is a plus but not required.

Ability to work in a fast-paced, high-volume healthcare environment. Must be able to manage multiple priorities while maintaining accuracy and excellent customer service. Flexibility to work additional hours as needed to meet business demands.