Job Description

Job Description

Job Description

emp Assignment About 6 weeks

We are seeking a  Prior Authorization Specialist for a temporary role in San Juan Capistrano. This position involves a combination of secretarial tasks and medical administration duties, including working with insurance and prior authorizations.

Key Responsibilities:

• Schedule Appointments : Coordinate patient visits.
• Insurance Verification : Confirm insurance before appointments.
• Patient Information : Input patient demographics and details.
• Collect Payments : Process co-pays and outstanding balances.
• Obtain Authorizations : Secure authorizations for visits (HMO, Workers' Comp).
• Prior Authorization : Execute the principles of prior authorization to ensure patients receive appropriate care at the right time and in the right setting.
• Problem Solving : Address complex prior authorization questions and issues.
• Eligibility & Benefits Check : Verify coverage for services like DME (Durable Medical Equipment) and home health before passing on requests for approval.
• Compliance : Ensure all authorizations meet required turnaround times and maintain compliance in all steps of the prior authorization process.
• Resource Management : Use supplies and equipment responsibly.
• HIPAA Compliance : Protect patient confidentiality at all times.
• Administrative Tasks :
• Answer phone calls.
• Sort and distribute mail and faxes.
• Manage medical records.
• Referrals :
• Coordinate patient referrals to specialists or diagnostic services.
• Obtain authorizations for referrals.
• Communicate with patients, providers, and insurance companies regarding the status of referrals.
• Maintain accurate referral records in compliance with HIPAA.

Required Skills & Qualifications:

• Medical Office Experience : Prior experience in scheduling, phone operations, and working in a medical setting.
• Communication : Strong written and verbal communication skills.
• Technical Skills : Intermediate proficiency in math and computer skills. Familiarity with medical software.
• Multitasking : Ability to prioritize and manage multiple tasks in a fast-paced, high-stress environment.
• Interpersonal Skills : Friendly, outgoing, and able to interact professionally with staff and patients at all levels.
• Confidentiality : Knowledge of HIPAA regulations and ability to maintain patient privacy.

This position requires someone who can handle changing priorities and solve complex prior authorization issues while maintaining a positive and professional attitude.

If you are organized, detail-oriented, and enjoy working in a healthcare setting, apply today!

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