Authorization Specialist

hace 2 semanas


Bogotá, Bogotá D.E., Colombia Outwork Staffing A tiempo completo
Job Summary

Outwork Staffing is seeking a highly skilled Pre-Authorization Specialist to join our team. As a key member of our medical group practice, you will play a crucial role in ensuring seamless patient care and operational efficiency.

Key Responsibilities
  • Verify Medical Insurance Coverage: Ensure accurate and timely verification of patient insurance coverage to facilitate smooth medical treatment.
  • Manage Insurance Portals: Effectively navigate and manage tasks through insurance provider portals to optimize administrative efficiency.
  • Apply ICD-10 and CPT Codes: Utilize knowledge of ICD-10 and CPT coding systems for accurate medical billing and documentation.
  • Determine Medical Necessity: Understand and apply rules of medical necessity to ensure accurate coverage authorizations.
  • Process Prior Authorization Requests: Evaluate and process prior authorization requests for patient medications and treatments.
  • Ensure Accurate Data Entry: Maintain accurate and up-to-date records through efficient data entry practices.
  • Evaluate Individual Requests: Assess individual patient requests for coverage authorizations and communicate with relevant parties.
  • Obtain Pre-Approval: Secure pre-approval from insurance companies for patient medications and treatments.
  • Communicate with Patients and Insurers: Effectively communicate with patients, insurers, and other relevant parties to ensure seamless care.
  • Review and Interpret Medical Documents: Analyze and interpret medical documents to inform accurate coverage decisions.
Requirements
  • Bachelor's Degree in Healthcare Administration or Related Field: Possess a degree in healthcare administration or a related field to ensure a strong foundation in medical terminology and procedures.
  • Strong Communication Skills: Develop strong communication skills to effectively interact with patients, insurance companies, healthcare providers, and other relevant parties.
  • Experience in Medical Insurance Verification: Possess experience in verifying medical insurance coverage to ensure accurate and timely verification.
  • Ability to Review and Interpret Medical Documents: Develop the ability to review and interpret medical documents to inform accurate coverage decisions.
  • Experience Evaluating Patient Requests: Possess experience evaluating patient requests for coverage authorizations to ensure accurate and timely processing.
  • Strong Understanding of ICD-10 and CPT Coding Systems: Develop a strong understanding of ICD-10 and CPT coding systems to ensure accurate medical billing and insurance claims.
  • Ability to Use Insurance Provider Portals: Possess the ability to efficiently use various insurance provider portals for submitting claims, reviewing coverage, and obtaining authorizations.
  • Excellent Organizational Skills: Develop excellent organizational skills, attention to detail, and ability to prioritize tasks effectively to ensure seamless patient care and operational efficiency.

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