Join our patient-centered healthcare team as a Prior Authorization/Billing Representative serving as the liaison between patients, providers and insurance companies. Daily responsibilities include verifying insurance coverage, obtaining approvals for procedures and patient account collections.
Duties/Responsibilities:
Review, submit and track procedure authorization and pre-certification requests
Communicate with insurance carriers via payer portals and phone to obtain approvals, authorizations, predeterminations and referrals as needed
Follow up with insurance companies, healthcare providers and patients to resolve and delays or issues in the authorization process
Collaborate with clinical staff, procedure schedulers and revenue cycle team to resolve authorization issues or denials
Support escalation of cases, including coordination of peer-to-peer reviews when required
Communicate authorization approvals or denials to the appropriate provider, facility and patient
Maintain detailed records of all authorization activities in the electronic health record (EHR) system
Stay updated on changes in insurance policies, authorization guidelines and referral processes to ensure compliance
Review daily provider office schedules to confirm patient's insurance is active and required referrals are in patient's chart
Work closely with Billing Coordinate to monitor patient accounts and provide follow up support
Required Skills/Abilities:
Familiarity with insurance plans, coverage policies and prior authorization requirements
Proficient use of EHRs and payer portals
Proficiency in medical terminology, ICD-10 and CPT coding
Strong organizational, communication and problem-solving skills
Ability to multitask and manage priorities in a fast-paced environment
Attention to detail and accuracy in documentation and communication
Knowledge of HIPAA regulations and patient confidentiality standards
Education/Experience and Other:
High school diploma or equivalent; associate degree or relevant certification in healthcare administration is a plus
Minimum 1 - 2 years of experience in a healthcare setting with medical billing, insurance verification or authorization/referral experience
Bilingual (Spanish) Required
eClinicalWorks EHR system experience a plus
Numbers & Facts
Location
Germantown, MD
Job Type
Full-time
Skills
Billingunmatched
Communication Skillsunmatched
Current Procedural Terminology (CPT)unmatched
Customer Escalationsunmatched
Dental Insuranceunmatched
Detail Orientedunmatched
Documentationunmatched
HIPAA (Health Insurance Portability and Accountability Act)unmatched
Health Insuranceunmatched
Healthcareunmatched
Healthcare Administrationunmatched
Healthcare Providersunmatched
High School Diplomaunmatched
ICD-10unmatched
Insuranceunmatched
Maintain Complianceunmatched
Medical Billingunmatched
Medical Record Systemunmatched
Medical Terminologyunmatched
Medical Treatmentunmatched
Multilingualunmatched
Multitaskingunmatched
Organizational Skillsunmatched
Patient Care Denialsunmatched
Patient Confidentialityunmatched
Problem Solving Skillsunmatched
Record Keepingunmatched
Regulationsunmatched
Spanish Languageunmatched
Vision Planunmatched
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