- Responsible for researching patient member benefits, additional coverages, coverage limitations, and general coverage allowances to obtain the necessary authorizations and referrals for patient services.
- Initiate and manage the prior authorization process for medical procedures, treatments, or medications.
- Prepare and submit prior authorization requests to insurance companies or healthcare payers according to established procedures.
- Ensure all required documentation, including clinical notes, medical history, and supporting documents, are complete and accurate.
- Processes prior authorizations and referral requests in a timely manner, prior to the patient’s services being rendered.
Job Requirement
- Bachelor’s degree in any discipline.
- 1 to 5 years of relevant experience Hands-on experience with RCM Medical Billing
- Strong knowledge of medical terminology, insurance policies, and healthcare reimbursement processes.
- Excellent communication, organizational, and problem-solving skills.
- Ability to work independently and collaboratively in a quick-paced, deadline-driven environment.
- eClinicalWorks experience will be an added advantage.
- Willing to work the night shift (any 9 hrs. between 6:30 pm 3:30 am)