Bilingual Insurance Prior Authorizations/Billing Representative
GERMANTOWN
Bilingual Insurance Prior Authorizations/Billing Representative
Full Time • GERMANTOWN
Benefits:
- 401(k)
- 401(k) matching
- Bonus based on performance
- Competitive salary
- Dental insurance
- Health insurance
- Paid time off
- Profit sharing
- Vision insurance
Join our patient-centered healthcare team as a Prior Authorization/Billing Representative serving as the liaison between patients, providers and insurance companies. Daily responsibilities include verifying insurance coverage, obtaining approvals for procedures and patient account collections.
Duties/Responsibilities:
Duties/Responsibilities:
- Review, submit and track procedure authorization and pre-certification requests
- Communicate with insurance carriers via payer portals and phone to obtain approvals, authorizations, predeterminations and referrals as needed
- Follow up with insurance companies, healthcare providers and patients to resolve and delays or issues in the authorization process
- Collaborate with clinical staff, procedure schedulers and revenue cycle team to resolve authorization issues or denials
- Support escalation of cases, including coordination of peer-to-peer reviews when required
- Communicate authorization approvals or denials to the appropriate provider, facility and patient
- Maintain detailed records of all authorization activities in the electronic health record (EHR) system
- Stay updated on changes in insurance policies, authorization guidelines and referral processes to ensure compliance
- Review daily provider office schedules to confirm patient's insurance is active and required referrals are in patient's chart
- Work closely with Billing Coordinate to monitor patient accounts and provide follow up support
Required Skills/Abilities:
- Familiarity with insurance plans, coverage policies and prior authorization requirements
- Proficient use of EHRs and payer portals
- Proficiency in medical terminology, ICD-10 and CPT coding
- Strong organizational, communication and problem-solving skills
- Ability to multitask and manage priorities in a fast-paced environment
- Attention to detail and accuracy in documentation and communication
- Knowledge of HIPAA regulations and patient confidentiality standards
Education/Experience and Other:
- High school diploma or equivalent; associate degree or relevant certification in healthcare administration is a plus
- Minimum 1 - 2 years of experience in a healthcare setting with medical billing, insurance verification or authorization/referral experience
- Bilingual (Spanish) Required
- eClinicalWorks EHR system experience a plus
Compensation: $20.00 - $23.00 per hour
About Us
We provide comprehensive high-quality and low cost gastrointestinal care. We listen to our patients and we understand that every person is different. We customize our approach so we can provide with the care that is right for everyone.
We have a multidisciplinary approach to digestive health and we work closely with patients, their primary care physician and other healthcare providers.
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