Prior Authorization Specialist at Sourcefit

Job Summary:

We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our growing team. In this role, you will be responsible for verifying insurance eligibility, obtaining prior authorization for medical services, and ensuring that all necessary documentation is in place for accurate billing. The successful candidate will possess excellent communication and organizational skills, as well as the ability to work independently and as part of a team.

Job Details:

• Prior Authorization Specialist
• Work from home
• Monday to Friday | 8 PM to 5 AM Manila Time
• *Following US Holidays

Responsibilities:

• Verify insurance eligibility and benefits for patients, ensuring all information is accurate and up to date.
• Obtain prior authorizations for medical services, working closely with healthcare providers, insurance companies, and patients.
• Maintain thorough and accurate records of all prior authorization requests, approvals, and denials.
• Communicate effectively with healthcare providers, patients, and insurance companies to resolve any issues related to prior authorizations and insurance verification.
• Monitor and track prior authorization statuses, following up as needed to ensure timely processing and approval.
• Collaborate with other team members, including medical billers and coders, to ensure efficient and accurate billing processes.
• Stay informed on the latest changes and updates to insurance policies, procedures, and regulations, applying this knowledge to the prior authorization process.

Qualifications:

• Minimum of 2 years experience in medical insurance verification, prior authorization, or a related role
• Familiarity with medical terminology, diagnostic codes (ICD-10), and procedure codes (CPT)
• Knowledge of insurance policies, procedures, and regulations, including Medicare, Medicaid, and private insurance companies
• Strong computer skills, including proficiency in Microsoft Office Suite.
• Excellent verbal and written communication skills, with the ability to effectively communicate with healthcare providers, patients, and insurance companies.
• Strong organizational skills and attention to detail, with the ability to manage multiple tasks and prioritize effectively.
• Ability to work independently and as part of a team in a fast-paced, deadline-driven environment.
• Experience working with electronic health record (EHR) systems, medical billing software, and insurance verification tools.