Billing Specialist Prior Authorization Jobs

​Microsoft Word and Excel experience required.

Meet with patients and set up financial agreements

Must be qualified to participate in Federal Health Programs, including Medicare/Medicaid.

Must be willing to travel for initial training.

Experience with Major Medical Insurance.

Knowledge of HCPC Codes (J-Codes).

Knowledge of ICD-10 Codes (Diagnoses Codes).

Ability to convert a prescription into an authorization request based on payer requirements.

Respond to urgent emails submitted by the PCC Team or Program Manager in a timely manner.

Familiar with medical documentation such as H&P’s, Genetic testing, etc.

Medical experience in prior authorizations is required.

40 hrs/week; Mondays - Fridays; between the hours of 8am - 6pm

When your work day ends, four seasons of recreation is right outside your door!

Experience with Major Medical Insurance.

Knowledge of HCPC Codes (J-Codes).

Knowledge of ICD-10 Codes (Diagnoses Codes).

Ability to convert a prescription into an authorization request based on payer requirements.

Respond to urgent emails submitted by the PCC Team or Program Manager in a timely manner.

Familiar with medical documentation such as H&P’s, Genetic testing, etc.

Perform administrative and data entry job functions, including analyzing and interpreting Microsoft Excel data and database management.

At least 2 years of experience working in a customer service, administrative assistant, or data entry-driven role

Spanish foreign language skills required

Strong problem-solving and critical thinking skills.

Solid organizational skills with the capability to support multiple simultaneous projects.

Strong technical (system) and computer skills with proficiency in Microsoft applications (e.g., Word, Excel, PowerPoint, etc.).

Server as a source of knowledge over the prior authorization procedures in multiple states.

Excellent verbal and written communication skills.

Ability to solve problems and manage multiple tasks simultaneously.

Professional telephone etiquette and communication skills

Knowledge of Cover My Meds Helpful, but not required.

Responsible to call both other providers and insurance companies to coordinate the processing of the prior authorization.

Advise management of identified trends with payers in an effort to mitigate problems

Communicate authorization and benefit coverage with patients and providers promptly and professionally

Able to organize workload and manage time effectively

Able to read and interpret medical benefits for verification requests

Exceptional written and verbal communication skills

Demonstrated experience working in prior authorizations (required)

A Bachelor's degree or an equivalent combination of education and experience.

Work with other OR schedulers and staff and communicate patient needs and responsibilities necessary prior to surgical procedures.

Fill OR time that is allocated to Departments and offer consultation on alternative dates or times to accommodate patients and staff.

Provide education and guidance to incoming providers and staff to onboard and understand the OR scheduling process.

Excellent written and verbal communication skills.

Demonstrates knowledge of effective strategies for working with diverse faculty, staff, and students.

∙ Acquiring and maintaining basic knowledge of relevant and changing Med D guidance.

∙ Bachelor’s degree in related field or equivalent work experience preferred.

Successfully worked independently in a data entry, productivity driven role is preferred.

In this role, you will be responsible for

∙ Utilizing multiple software systems to complete Medicare Prior Authorization case reviews.

∙ Meeting or exceeding government mandated timelines

Must have medical billing and authorizations experience

Excellent communication & interpersonal skills

Microsoft Office skills including Excel and Word (Typing Test will be conducted at Interview)

Ability to answer multiple phone lines with proper phone etiquette

Work well in a fast-paced environment

Ability to prioritize tasks, handle pressure, and delicate situations

Must possess excellent time management and organization skills with attention to detail.

Education / Experience / License and Certifications

Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriately in the system.

Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes.

Knowledge of CPT, HCPCS, and ICD-10 codes preferred.

Verifies physician orders are accurate, determines CPT, HCPCS and ICD-10 codes for proper Prior Authorization.

Scrubbing and auditing charts for correction and completeness

Billing research for new items and services

Key Approaches to the Work:

A predictable schedule and dedicated individualized paid training

(We contribute to your 401K after an allotted period of time)

Medical/Vision/Dental, with extended mental health coverage

Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.

Possess a working knowledge and understanding of ICD-9 and CPT codes required.

Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.

Maintains the Logan Health intranet related to payer requirements needed to successfully obtain a prior authorization.

Notice of Pre-Employment Screening Requirements

Possess insight and understanding into reimbursement and claims procedures and its direct impact on the revenue cycle required.

Scrubbing and auditing charts for correction and completeness

Billing research for new items and services

Key Approaches to the Work:

A predictable schedule and dedicated individualized paid training

(We contribute to your 401K after an allotted period of time)

Medical/Vision/Dental, with extended mental health coverage