Prior Authorization Representative

Prior Authorization Representative Job Description 

Client Profile- An Indiana based Independent Physician-Owned radiology practices founded in 1967.   

Job Summary- Prior Authorization Representative is responsible for securing inpatient/outpatient accounts by performing insurance verification, obtaining benefit information, calculating patient estimates and obtaining prior authorizations before service are rendered.  Must be comfortable working with clinical professionals. 

Job Duties 

• Verify insurance eligibility, benefits, network status and create pre-service liability estimate. 
  

• Ensure accurate ICD, CPT codes and related medical records are submitted in the authorization request. 
  

• Secure prior authorizations of inpatient and outpatient imaging. 
  

• Acts as a liaison between the payer and clinic schedulers/medical support. 
  

• Follows up on delayed or denied authorizations requests and escalates for resolution. 
  

• Create detail documentation and maintain/stores the authorization paper trail. 
  

Qualifications 

• High School Diploma, 3+years of experience in a health care financial setting or medical office setting. Must have previous prior authorization experience. 
  

• Excellent customer service skills, strong attention to details, multi-task as needed. 
  

• Must be familiar with an EMR or HER; Microsoft Office 365 
  

• Must be able to take responsibility and work under pressure.  Work efficiently in a busy medical office. 
  

• Must be a positive team player. 
  

• Knowledge of ICD-10, CPT, and HCPCS codes specific to radiology is a plus. 
  

• Proficient in medical terminology, especially radiological terms and procedures. 
  

• Days/Hours: M/F 8a to 5pm (Availability to start as early as 7a and work as last as 6:00pm is a plus) 
  

• Starting pay $20.00 to $21.00 hourly (Based on experience)