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About The Position
Prior Authorization Representative
At Clinical Associates, we make being healthy easier. As a premier multi-specialty physicians’ practice located in the Towson, Pikesville, and Reisterstown communities, we connect our patients to a seamless system of integrated medical care. Our practice includes in-house specialists in areas of medicine, from cardiology to podiatry. We also offer unique services like our nuclear stress testing facility.
We are seeking to add an experienced and detail-oriented Prior Authorization Representative to our Cardiology team! Our ideal candidate will possess 1-2 years of experience in a healthcare setting with solid working knowledge of insurance verification & eligibility along with obtaining prior authorizations for office procedures and diagnostic testing. The candidate must be a team player and provide excellent customer service to our patients.
Shift Hours: Full Time / Monday – Friday 8:30 am – 4:30 pm
Location: Towson – 515 Fairmount Avenue or Pikesville – 1838 Greene Tree Road
This is an in-person onsite position. No hybrid or remote work options are available.
Requirements
- High School Diploma or equivalent
- Medical office or health care experience is required.
- 1-2 years of proven experience in healthcare insurance verification / prior authorization or billing is required.
- Strong attention to detail and organizational skills.
- Strong time management skills.
- Knowledge and understanding of CPT/ICD 10 coding and billing protocols.
- Excellent verbal communication skills with ability to hear and to speak standard English clearly and concisely.
- Excellent written communication skills with ability to read, write and spell standard English clearly and concisely.
- Ability to interact effectively with culturally diverse patients, practitioners, and employee population.
- Ability to convey a positive attitude and project a professional image.
- Ability to remain flexible and maintain confidentiality.
- Possesses excellent time management skills.
Nice To Haves
- Specialty medicine and/or Cardiology are a plus.
- Experience with EPM/EMR – specifically NextGen is a plus.
Responsibilities
- Runs appointment lists and verifies insurance coverage along with identifying which patients need prior authorizations for scheduled appointments, procedures, and diagnostic testing.
- Completes the prior authorization process 2 weeks prior to the scheduled appointments.
- Contacts patients to inform them of their financial out-of-pocket costs: co-pay, deductible, and co-insurance amounts.
- Confirms if referrals have been received prior to scheduled appointments.
- Contacts primary care providers or other healthcare facilities as needed to obtain referrals or missing information for office visits or procedures.
- Contacts insurance companies to confirm continued coverage or to resolve billing issues, discrepancies, or denials.
- Accurately enters and updates patient demographics, insurance information, and authorization and referral tracking into the EMR system.
- Schedules appointments
- Other duties as assigned to support the overall workflow efficiency of the department.
Benefits
- Paid Time Off
- Medical
- Vision
- Dental
- Life Insurance
- Paid Holidays
- 401K(matching)