Prior Authorization Specialist: Fast Pre-Auth & Verification

Shoreline Healthcare Technologies; United States; Hybride; USD 42 000 - 64 000; Plein temps

Résumé du poste

Shoreline Healthcare Technologies is seeking an experienced insurance authorization specialist to obtain pre-service treatment authorizations and verify patient insurance eligibility across Orthopedics, Cardiology, Oncology, and Pain Management. The role involves verifying benefits, copay requirements, and documenting all communications efficiently.

The candidate will interact with insurance carriers, review medical history for authorization needs, and follow HIPAA-compliant procedures.

Qualifications

• 1+ years experience in medical prior authorization or eligibility verification.
• Familiarity with CPT surgical codes, ICD-10 medical necessity criteria, and payer portals.
• Strong organizational skills and ability to manage urgent pre-procedure requests.

Responsabilités

• Obtain pre-service treatment authorizations and verify patient insurance eligibility, benefits coverage, and copay requirements across major medical specialties.
• Contact insurance carriers to verify patient insurance eligibility, benefits and requirements.
• Review patient medical history and provide pertinent information for authorization requirements.
• Input patient information and update system as needed.
• Monitor schedule and work with hospital to obtain authorizations for add-on procedures.
• Demonstrate knowledge of medical terminology including HIPAA regulations.
• Clearly document all communications in the patient chart.
• Communicate insurance trends or changes to the team.
• Adhere to all policies and perform other duties as assigned.

Connaissances

Prior authorization

Eligibility verification

CPT/ICD-10 familiarity

Organizational skills

Description du poste

Shoreline Healthcare Technologies is seeking an experienced insurance authorization specialist to obtain pre-service treatment authorizations and verify patient insurance eligibility across Orthopedics, Cardiology, Oncology, and Pain Management. The role involves verifying benefits, copay requirements, and documenting all communications efficiently.

The candidate will interact with insurance carriers, review medical history for authorization needs, and follow HIPAA-compliant procedures.