Prior Authorization Specialist — Healthcare Claims & Appeals

Cumberland Healthcare (Cumberland Memorial Hospital); Cumberland (ME); Sur place; USD 42 000 - 60 000; Plein temps

Avantages offerts par ce poste

Competitive wage and benefits

Résumé du poste

Cumberland Healthcare in Maine is seeking a Prior Authorization Specialist to join our team. The role centers on obtaining prior authorizations from insurance companies for healthcare providers and ensuring timely, accurate approvals.

This position requires verifying coverage, reviewing medical records, and assessing eligibility. Responsibilities include communicating with insurers, tracking cases, updating patient insurance information, managing work queues and denials, and supporting the

Qualifications

• Experience with prior authorizations required.
• Strong customer service and clerical skills.
• Experience working with insurance companies required.
• Education/experience working with Medical Terminology preferred.
• Knowledge of CPT and ICD-10 Coding.
• Advanced computer skills.
• Positive attitude in a fast-paced team environment.

Responsabilités

• Obtain prior authorizations from insurance providers.
• Verify insurance coverage and assess eligibility for services.
• Review medical records as part of the authorization process.
• Communicate with insurers and track cases.
• Update patient insurance information and manage work queues.
• Support the appeal process when denials occur.

Connaissances

Prior Authorization

Customer Service

Insurance Communication

Medical Terminology

CPT & ICD-10

Advanced Computer Skills

Team Player

Formation

Medical Terminology knowledge preferred

Description du poste

Cumberland Healthcare in Maine is seeking a Prior Authorization Specialist to join our team. The role centers on obtaining prior authorizations from insurance companies for healthcare providers and ensuring timely, accurate approvals.

This position requires verifying coverage, reviewing medical records, and assessing eligibility. Responsibilities include communicating with insurers, tracking cases, updating patient insurance information, managing work queues and denials, and supporting the