Prior Authorization, Referral And Clinical Documentation Specialist

If you are looking for a challenging position in the healthcare industry where you can utilize your skills in medical coding, insurance verification, and office administration, then this role may be perfect for you. Apply today to join our team as a Prior Authorization, Referral, and Clinical Documentation Specialist!

Individual must be experienced in submitting and tracking Prior Authorizations through website portals, fax, and telephone. Must be comfortable using EHR, editing PDF documents and the use of other applications. The ideal candidate is required to have familiarity with medical terminology and commonly prescribed medications in the primary care setting; and must also have fast but accurate typing skills; and excellent English listening, writing and speaking skills. He/She must be self-motivated and be capable of working independently with minimum supervision.

Your scheduled hours are Monday - Wednesday (7:30 AM - 5 PM), Thursday (8:30 AM - 6 PM), and Friday (7:30 AM - 1 PM). The work schedule is subject to change.

.HOW TO APPLY:

• Complete pre-screening questionnaire

• Complete pre-hire assessment: https://app.testgorilla.com/s/sm6hudo9

• Check your Junk Mail folder if pre-hire assessment invitation does not arrive in your Inbox

• Applicants failing to follow application instructions will not be considered

Duties and Responsibilities:

• Verify insurance coverage and eligibility for patients
• Assist patients by coordinating referral appointments and working with insurance companies and specialist providers to share essential patient information.
• Follow up on referrals to ensure timely patient-specialist contact.
• Follow up on pending referrals and authorizations, and provide updates to healthcare providers
• Complete Prior Authorizations for medications, referrals and procedures timely and accurately
• Perform general administrative or clerical tasks such as answering phone calls and emails, maintaining patient records, and verifying insurance information before appointments.
• Set appointments, send reminders, and provide patients with information about specialist referral appointments.
• Review medical records and documentation to determine the need for Prior Authorizations
• Ensure that medical procedures and treatments are approved by insurance companies before they are performed.
• Review medical records, verify insurance coverage, and obtain the necessary authorizations.
• Provide general administrative and clerical support such as answering phone calls and emails.
• Maintain accurate records of all referrals and Prior Authorization activities
• Provide timely reports on referrals and prio authorizations
• Perform other duties as assigned by the providers.

Job Requirements and Qualifications:

• Allied Healthcare professional with managed care experience is preferred
• Have strong knowledge of medical office procedures and practices
• Must have experience with insurance verification and benefit determination processes
• Must be proficiency in medical coding, including knowledge of ICD-10 codes
• Must have a sense of ownership and be task-driven.
• Must be Technology savvy, accountable, responsible, confident, and self-driven.
• Have a Strong understanding of medical terminology, anatomy, medications, abbreviations, charting, etc.
• Have advanced verbal and Written English communication skills.
• Must have a typing speed of at least 50 words per minute.
• Must be able and willing to Perform General Administrative Tasks as part of a team.
• Have strong listening skills, proactive communication, attention to detail, and the ability to meet a deadline.
• Must have excellent organizational; problem solving; time management; communication; attention to detail; and great customer service skills.
• Must be a team player and willing to communicate with other practice staff.
• Must have a broad knowledge of various EHR systems and be quick to learn new EHR systems is needed.
• Must have excellent understanding of HIPAA regulations and guidelines
• Must be self-motivated, dedicated, and have a distraction-free HIPAA compliant workspace in the home office.

Job Types: Full-time, Part-time, Contract

Pay: $16.00 - $19.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Health insurance
• Paid time off
• Referral program
• Retirement plan

Weekly day range:

• Monday to Friday

Ability to Relocate:

• Burleson, TX 76028: Relocate before starting work (Required)

Work Location: Hybrid remote in Burleson, TX 76028