Prior Authorization Clerk

JOB DUTIES:

• Collect all necessary documentation to perform proper authorizations
• Verify prior authorization and/or pre-service requirements are met
• Manage and maintain all outstanding authorization accounts to increase billing of clean claims
• Research patient accounts due to invalid and/or missing authorization information to resolve denials
• Document eligibility, benefit, and authorization information in accordance with established guidelines
• Contact the patient or provider, as needed, for additional information and completion of required documentation to obtain prior authorization
• Interact with providers, patients, insurance companies, and others as necessary to request prior authorizations
• Document account activity; update patient and claim information; and demonstrate proficiencies within the billing system for efficient processing of claims
• Maintain confidentiality of all information according to HIPAA and company policy

The Prior Authorization Clerk assumes other responsibilities as assigned.

JOB REQUIREMENTS:

• Analytical ability to apply criteria and evaluate information to make decisions
• Strong verbal and written communication skills; and excellent interpersonal skills in teaming with patients, medical staff, and the public
• Detail-oriented with proven ability to work in a fast-paced environment
• Computer skills including MSOffice, Outlook, Meditech, preferred
• Ability to move, position self, consistently operate various types of equipment, able to detect/observe/identify details at close or distant range with or without accommodations as well as exerting 20 to 50 pounds occasionally, or 10 to 25 pounds frequently, or up to 10 pounds constantly

EDUCATION AND EXPERIENCE:

• S. Diploma, G.E.D. or equivalent work experience in field, required

• Medical billing certification, preferred
• 1-2 years’ experience in medical billing or insurance claims, preferred