Virtual Medical Prior Authorization Specialist

MUST BE FLUENT IN ENGLISH AND SPANISH • MUST HAVE PRE-AUTH EXPERIENCE* Job Posting: Virtual Medical Office Prior Authorization Specialist (Orthopedic Practice) Position Type: Full-Time About Us: We are a leading orthopedic practice committed to offering exceptional care to our patients. We pride ourselves on using the latest technology and treatment options to improve the quality of life for our patients. We are currently seeking a dedicated Virtual Medical Office Assistant to join our team and help us continue to provide world-class service. Job Summary: The virtual Prior Authorization Specialist is essential to the healthcare system, responsible for coordinating timely access to medical services and treatments by effectively liaising with healthcare providers and insurance companies. This role demands a solid understanding of managed care protocols, medical coding, and insurance verification to ensure prompt authorization of patient care. The ideal candidate will demonstrate excellent organizational abilities, sharp attention to detail, and a strong commitment to upholding HIPAA compliance. Responsibilities: Review and process prior authorization requests for medical services and procedures. Communicate with healthcare providers to obtain necessary documentation for authorization. Verify patient insurance coverage and eligibility for services. Utilize CPT coding, ICD-9, and ICD-10 codes accurately in the authorization process. Maintain accurate and up-to-date medical records in compliance with HIPAA standards. Collaborate with medical office staff to ensure efficient workflow and patient care continuity. Address any issues or denials related to prior authorizations promptly. Stay informed about changes in insurance policies, managed care regulations, and medical terminology. Answer incoming phone calls from new patients, provide information on our services, and schedule initial consultations. Collect, and securely store digital medical information while ensuring accuracy and compliance with HIPAA regulations. Facilitate communication between patients and medical office staff, to ensure seamless delivery of care. Update and maintain the electronic health record system with up-to-date patient information. Perform administrative tasks such as data entry, medical records, and coordinating with external medical facilities for record transfers. Assist with additional tasks as assigned by the Office Manager or medical staff. Qualifications: Prior experience in a medical or dental office setting is preferred. Solid understanding of managed care procedures and insurance verification practices. Knowledge of medical coding systems such as CPT, ICD-9, and ICD-10. Proficient in medical terminology and medical records management. Strong written and verbal communication skills. Capable of working both independently and collaboratively in a fast-paced environment. Highly detail-oriented with excellent organizational skills and the ability to manage multiple tasks efficiently. Apply tot his job