Prior Authorization Specialist
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Job Description
Prior Authorization Specialist securing insurance approvals and correcting denials for Triton Medical Solutions’ medical billing clients. Remote US role handling CPT/ICD coding and payer calls.
Responsibilities:
- Review procedure requests to determine required authorizations based on insurance standards
- Review documentation and contact providers to supplement orders and establish medical necessity
- Contact physician offices, customer service departments, and insurance carriers to resolve missing information and obtain prior authorizations
- Submit authorizations using correct CPT and diagnosis codes
- Review denied prior authorizations and take corrective action
- Maintain up-to-date information on insurance companies and relevant changes
- Handle incoming and outgoing calls concerning clinical documents and insurance benefits
- Provide quality customer service to clients
- Work extensively by phone with insurance companies
- Collaborate cordially with the team and participate in meetings
- Participate in projects and complete other tasks assigned by the Team Leader or management
- Maintain confidentiality and adhere to HIPAA guidelines and regulations
Requirements:
- High school diploma
- 1-2 years in a customer service oriented environment preferred
- 1-2 years working within the insurance industry in a provider’s office, insurance company, or company where involved with employee benefits preferred
- Ability to work independently, give attention to detail, prioritize and perform several tasks together without losing concentration
- Knowledge of insurance cards, medical insurance terminology, medical benefits, and CPT and ICD 9/10 coding
- Ability to follow established procedures
- Excellent typing and computer usage skills, including Microsoft Word and Excel proficiency
- Good oral and written English communication skills
- Well organized and detail-oriented
- Own computer meeting the company’s IT requirements
Benefits:
- Flexible schedule
- Remote work arrangement
- Approximately 40 hours per week
- Independent Contractor work relationship
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