Prior Authorization Specialist

Assist Point Inc; Frisco (TX); On-site; USD 45,000 - 65,000; Full time

Job summary

Assist Point Inc. in Frisco, TX is seeking a detail-oriented Prior Authorization Specialist who will manage and process prior authorization requests to ensure timely approvals for medical services and medications.

The role requires verifying insurance coverage, communicating with insurers, and maintaining accurate records, collaborating with providers and patients to resolve issues while ensuring compliance with regulatory policies.

Qualifications

• Must have a high school diploma or equivalent.
• Associate's or Bachelor's degree is preferred.
• Experience in prior authorization or medical billing is a plus.
• Strong knowledge of insurance plans and medical terminology.
• Excellent communication and organizational skills.
• Proficient with EMR systems and Microsoft Office.

Responsibilities

• Review and process prior authorization requests from providers.
• Communicate with insurers to obtain approvals.
• Verify patient coverage and eligibility.
• Maintain accurate records of authorization activity.
• Collaborate with providers, patients, and insurers to resolve issues.
• Ensure compliance with policies and regulations.
• Provide timely updates on status to patients and providers.

Skills

Healthcare knowledge

Communication

Independent work

Education

High school diploma

Associate's or Bachelor's degree preferred

Tools

EMR systems

MS Office

Job description

We are seeking a detail-oriented and organized Prior Authorization Specialist to join our team. The ideal candidate will be responsible for managing and processing prior authorization requests to ensure timely approval of medical services and medications for our patients.

Responsibilities

• Review and process prior authorization requests submitted by healthcare providers.
• Communicate with insurance companies to obtain necessary approvals for medical procedures, treatments, and medications.
• Verify patient insurance coverage and eligibility.
• Maintain accurate and up-to-date records of all prior authorization activities.
• Collaborate with healthcare providers, patients, and insurance representatives to resolve any issues or denials.
• Ensure compliance with all regulatory and organizational policies related to prior authorizations.
• Provide timely updates to patients and providers regarding the status of their authorization requests.

Qualifications

• High school diploma or equivalent; Associate's or Bachelor's degree preferred.
• Previous experience in prior authorization, medical billing, or healthcare administration is a plus.
• Strong knowledge of insurance plans, medical terminology, and healthcare regulations.
• Excellent communication and interpersonal skills.
• Ability to work independently and manage multiple tasks efficiently.
• Proficient in using electronic medical records (EMR) systems and Microsoft Office Suite.