Pre-Authorization Specialist at Georgia Eye Institute of the Southeast LLC

Description

The Pre-Authorization Specialist is responsible for ensuring that all medical services requiring pre-authorization are approved by insurance providers before patient appointments or treatments. This role involves working closely with healthcare providers, insurance companies, and patients to confirm that all required pre-certifications and authorizations are obtained efficiently. The specialist will play a key role in minimizing delays in patient care, reducing claim denials, and ensuring compliance with insurance policies and procedures.

Key Responsibilities:

1. Authorization and Verification:

• Obtain prior authorizations for required medical procedures, diagnostic tests, surgeries, medications, and treatments.
• Verify patient insurance coverage and eligibility for scheduled services.
• Submit necessary documentation and clinical information to insurance companies to facilitate approval of services.

2. Communication and Coordination:

• Communicate effectively with insurance providers, medical staff, and patients regarding authorization status, requirements, and any issues that may impact treatment.
• Collaborate with healthcare providers to gather additional information needed for authorization approvals.
• Educate patients on their coverage details, out-of-pocket responsibilities, and any prior authorization requirements.

3. Documentation and Tracking:

• Maintain accurate records of authorization status, approvals, denials, and any related communications.
• Track and follow up on pending authorizations to ensure timely responses and avoid delays in patient care.
• Document all actions taken in patient records and keep detailed logs for audit and billing purposes.

4. Insurance and Denial Management:

• Assist with addressing denied authorizations by gathering additional information or resubmitting requests as needed.
• Work with billing and claims departments to resolve pre-authorization issues that result in claim denials.
• Monitor trends in authorization denials to identify and communicate areas for improvement.

5. Compliance and Policy Adherence:

• Stay up-to-date on insurance company policies, state and federal healthcare regulations, and pre-authorization requirements.
• Adhere to all HIPAA regulations and ensure patient confidentiality throughout the pre-authorization process.
• Participate in training and quality assurance programs to maintain a high standard of work.

Requirements

Qualifications:

• Education: High school diploma or GED required; associate degree in finance, accounting, or healthcare administration preferred.
• Experience: 1-2 years of experience in healthcare pre-authorization, billing, or insurance verification, preferably in a medical office or hospital setting.
• Technical Skills: Proficiency in practice management software, electronic health records (EHR), and Microsoft Office (Excel, Word, Outlook and Teams).
• Knowledge: Strong understanding of medical terminology, ICD-10 and CPT coding, and insurance industry practices.
• Attention to Detail: Exceptional attention to detail and accuracy in financial analysis and data entry.
• Organizational Skills: Strong organizational and time management skills with the ability to handle multiple tasks and prioritize effectively.
• Communication Skills: Excellent verbal and written communication skills, with the ability to communicate clearly with patients, staff, and external parties.
• Problem-Solving: Strong analytical and problem-solving skills, with the ability to identify and resolve discrepancies in patient accounts.
• Teamwork: Ability to work collaboratively with other departments and contribute to a positive team environment.

Work Environment:

• Office  Setting: This position typically works in an office setting with standard hours.
• Remote Work: We do offer a hybrid schedule if interested.
• Physical Requirements: Ability to sit for extended periods, use a computer, and perform repetitive tasks.

Compensation and Benefits:

• Competitive salary based on experience.
• Comprehensive benefits package, including health and dental insurance.
• Paid time off (PTO).
• Opportunities for professional development and advancement.