A Prior Authorization Specialist is responsible for reviewing medical records to determine if treatm Job at Superior Mobile Health, San Antonio, TX

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  • Superior Mobile Health
  • San Antonio, TX

Job Description

Job Description

Job Description

Prior Authorization Specialist

Employment Status: Full-time

FLSA: Non-Exempt

Reports to: Billing Manager

Revised Date: 1 Apr 2025 April 2025

A Prior Authorization Specialist is responsible for reviewing medical records to determine if treatments, procedures, or medications require prior authorization. They also verify insurance information, process authorization requests, collaborate with other healthcare professionals, monitor and follow up, manage denials, and communicate with patients. Review Medical Records a Prior Authorization Specialist meticulously examines patient records to determine if treatments, procedures, or medications require prior authorization, ensuring that each case is assessed accurately according to Insurance carrier requirements.

ESSENTIAL FUNCTIONS

  • Review and assess prior authorization requests for various medical services, procedures, and medications.
  • Verify patient insurance benefits and eligibility through comprehensive intake processes.
  • Communicate with healthcare providers, insurance companies, and patients to gather and confirm required information.
  • Maintain accurate records of all prior authorization requests, documenting approvals and denials.
  • Follow up on outstanding authorizations to ensure timely decisions and facilitate patient care.
  • Stay up-to-date with changes in insurance policies, regulatory requirements, and procedural guidelines specific to healthcare.
  • Assist in training and mentoring new staff members regarding the prior authorization process and best practices.

COMPETENCIES

  • Attention to detail
  • Communication skills
  • Analytical skills
  • Organizational skills
  • Problem-solving skills
  • Technical proficiency

MINIMUM REQUIREMENTS

  • Must have a High School Diploma or GED.
  • Knowledge of Medical Terminology and Medical Insurance (Is a plus, but not required)
  • Knowledge of HIPPA requirement (Is a plus, but not required)
  • Working knowledge of Office products (Excel, PowerPoint, Word, etc.)

BENEFITS

- Health Insurance (Medical, Dental, Vision)

- 401k with company

- PTO (paid time off)

PHYSICAL DEMANDS AND WORKING CONDITIONS

Working conditions are office space. Will be required to sit and monitor a computer screen for extended periods of time. Must be to communicate in a clear and professional manner. Should be able to lift or carry 25lbs.

JOB TYPE, PAY, AND WORKING LOCATION

Job Type: Full-time

Pay Range: $17 - $21.50 (based on experience

Work Location: In person

Job Posted by ApplicantPro

Job Tags

Full time,

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