Job Description

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.  
  

Requirements

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.  
  

• K nowledge 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) 
  

Job Tags

Similar Jobs