Insurance Prior Authorizations/Billing Representative

Digestive Care Specialists, LLC; Germantown (MD); On-site; USD 40,000 - 55,000; Full time

Benefits offered by this job

401(k)

401(k) matching

Bonus based on performance

Competitive salary

Dental insurance

Health insurance

Paid time off

Profit sharing

Vision insurance

Job summary

Digestive Care Specialists, LLC in Germantown, MD seeks a Prior Authorization/Billing Representative to act as liaison between patients, providers, and insurers, handling verifications and approvals daily.

You will manage pre-certifications, communicate with carriers, resolve authorization issues, and maintain accurate EHR records, ensuring timely patient access.

Qualifications

• High school diploma or equivalent; associate degree or healthcare certification is a plus.
• Minimum 1–2 years in healthcare settings with billing, verification or authorization experience.
• Bilingual (Spanish) required; experience with eClinicalWorks is a plus.

Responsibilities

• Review, submit and track procedure authorization and pre-certification requests.
• Communicate with insurance carriers via payer portals and phone to obtain approvals, authorizations, predeterminations and referrals as needed.
• Follow up with insurers, providers and patients to resolve delays or issues in the authorization process.
• Collaborate with clinical staff, procedure schedulers and revenue cycle teams to resolve authorization issues or denials.
• Escalate cases, including coordination of peer-to-peer reviews when required.
• Communicate authorization approvals or denials to the appropriate provider, facility and patient.
• Maintain detailed records of all authorization activities in the EHR system.
• Stay updated on changes in insurance policies, authorization guidelines and referral processes to ensure compliance.
• Review daily provider office schedules to confirm patient’s insurance is active and required referrals are in patient’s chart.
• Work closely with Billing Coordinator to monitor patient accounts and provide follow up support.

Skills

Insurance verification

Prior authorization

Medical billing

EHR proficiency

Payer portals

HIPAA compliance

Attention to detail

Multitasking

Education

High school diploma or equivalent

Associate degree or healthcare certification (plus)

Tools

eClinicalWorks

Job description

Benefits:

• 401(k)


• 401(k) matching


• Bonus based on performance


• Competitive salary


• Dental insurance


• Health insurance


• Paid time off


• Profit sharing


• Vision 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 requests


• Communicate with insurance carriers via payer portals and phone to obtain approvals, authorizations, predeterminations and referrals as needed


• Follow up with insurance companies, healthcare providers and patients to resolve and delays or issues in the authorization process


• Collaborate with clinical staff, procedure schedulers and revenue cycle team to resolve authorization issues or denials


• Support escalation of cases, including coordination of peer-to-peer reviews when required


• Communicate authorization approvals or denials to the appropriate provider, facility and patient


• Maintain detailed records of all authorization activities in the electronic health record (EHR) system


• Stay updated on changes in insurance policies, authorization guidelines and referral processes to ensure compliance


• Review 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 support

Required Skills/Abilities:

• Familiarity with insurance plans, coverage policies and prior authorization requirements


• Proficient use of EHRs and payer portals


• Proficiency in medical terminology, ICD-10 and CPT coding


• Strong organizational, communication and problem-solving skills


• Ability to multitask and manage priorities in a fast-paced environment


• Attention to detail and accuracy in documentation and communication


• Knowledge of HIPAA regulations and patient confidentiality standards

Education/Experience and Other:

• High school diploma or equivalent; associate degree or relevant certification in healthcare administration is a plus


• Minimum 1 - 2 years of experience in a healthcare setting with medical billing, insurance verification or authorization/referral experience


• Bilingual (Spanish) Required


• eClinicalWorks EHR system experience a plus