Medical Claims Processing jobs

Overview
Join our dynamic healthcare team as a Prior Authorization Specialist, where your expertise will drive efficient patient care and streamline insurance processes. In this vital role, you will serve as the key liaison between healthcare providers, insurance companies, and patients to secure necessary approvals for medical services. Your proactive approach and attention to detail will ensure timely authorization, reducing delays and enhancing patient satisfaction. This position offers an exciting opportunity to make a meaningful impact in a fast-paced, supportive environment dedicated to excellence in healthcare administration.

Responsibilities

• Review medical documentation and verify insurance coverage to determine eligibility for prior authorization requests.
• Prepare and submit accurate prior authorization requests using appropriate managed care protocols and coding standards.
• Collaborate with healthcare providers to gather necessary medical records, clinical notes, and supporting documentation for authorization submissions.
• Utilize medical terminology, CPT (Current Procedural Terminology) codes, ICD-9/ICD-10 (International Classification of Diseases) codes, and ICD coding guidelines to ensure precise claim processing.
• Track and follow up on pending authorizations, ensuring timely responses from insurance carriers.
• Maintain strict compliance with HIPAA regulations to protect patient confidentiality during all stages of the authorization process.
• Document all communications, approvals, denials, and appeals accurately within medical records systems.

Qualifications

• Proven experience in managed care or medical office settings with a strong understanding of insurance verification processes.
• Familiarity with medical terminology, medical records management, and medical coding including CPT, ICD-9, ICD-10, and ICD coding standards.
• Prior experience working in dental or other specialty medical offices is a plus.
• Knowledge of HIPAA regulations to ensure confidentiality and privacy of patient information.
• Strong organizational skills with the ability to manage multiple requests simultaneously while maintaining attention to detail.
• Excellent communication skills for effective collaboration with healthcare providers and insurance representatives.
• Office experience involving medical records management or insurance processing is highly desirable. This role is perfect for motivated professionals eager to contribute their expertise in a collaborative environment that values accuracy, efficiency, and compassionate patient care. Join us in making a difference by facilitating seamless access to essential healthcare services!

Work Location: Remote