Hybrid Pre-Authorization Specialist (Healthcare)

Premier Medical Resources; Houston (TX); Hybrid; USD 42,000 - 62,000; Full time

Benefits offered by this job

Medical plans (3)

Vision plans (2)

Employee Assistance Program

Disability Insurance

401(k) with 2-year vesting

PTO + Holidays

Job summary

Premier Medical Resources, a healthcare management company in Northwest Houston, Texas, seeks a full-time Pre-Authorization Specialist. The role focuses on obtaining pre-certifications, pre-authorizations, and referrals with guidance from the Revenue Cycle Manager.

The position offers a hybrid work model after 30-90 days of in-person training, with responsibilities spanning CPT/ICD-10 coding, payer verification, and coordination across departments. Background check and drug screening apply.

Qualifications

• Knowledge of insurance verification and patient responsibility.
• Familiarity with ICD-10 and CPT codes and procedures.
• Ability to review medical documentation and understand medical necessity.

Responsibilities

• Prioritize authorization requests by urgency.
• Generate and oversee authorization/referral processes.
• Handle day-to-day pre-authorization issues and follow up.
• Notify departments for approvals/denials and coordinate appeals.

Skills

In/out-of-network insurances

ICD-10 CPT codes

Review medical documentation

Medical necessity requirements

Task-oriented & organized

Detail-oriented

Independent and team work

Flexible/adaptable

Downtime efficiency

Education

High school diploma or GED

2 years medical office/facility experience

Job description

Premier Medical Resources, a healthcare management company in Northwest Houston, Texas, seeks a full-time Pre-Authorization Specialist. The role focuses on obtaining pre-certifications, pre-authorizations, and referrals with guidance from the Revenue Cycle Manager.

The position offers a hybrid work model after 30-90 days of in-person training, with responsibilities spanning CPT/ICD-10 coding, payer verification, and coordination across departments. Background check and drug screening apply.