Medical Insurance Pre-Authorization Officer 04F25

The Medical Insurance Pre-Authorization Officer plays a crucial role in the healthcare administration process by ensuring that medical procedures and services are approved by insurance companies before they occur. This role involves reviewing medical plans, verifying patient insurance coverage, and obtaining the necessary pre-authorization from insurance providers to avoid unnecessary costs and complications. The position requires a keen understanding of medical terminology, insurance processes, and patient care services. A successful Pre-Authorization Officer ensures efficiency, reduces delays in patient care, and maintains a seamless flow of communication among healthcare providers, insurers, and patients. This role is pivotal in fostering patient satisfaction and operational efficiency within the healthcare organization.

Responsibilities

• Review medical procedures and documentation to assess insurance approval requirements thoroughly.
• Contact insurance companies to initiate pre-authorization for medical services promptly.
• Verify and confirm patient insurance coverage and benefits for proposed care plans.
• Collect and provide accurate patient information to insurance companies for pre-authorization.
• Communicate effectively with healthcare providers to resolve any coverage disputes or issues.
• Update and maintain accurate records of all authorization requests and outcomes.
• Educate patients about their insurance coverage and the pre-authorization process when necessary.
• Monitor and follow up on pending authorization requests to ensure timely approval before services.
• Collaborate with billing departments to verify the accuracy of coding and claims submissions.
• Stay informed about changes in insurance policies, guidelines, and state regulations.
• Assist in resolving complex issues related to denied or delayed authorizations efficiently.
• Participate in team meetings and contribute valuable insights on improving authorization workflows.

Requirements

• Associate's degree in healthcare administration or a related field preferred.
• Minimum of two years of experience in medical insurance pre-authorization or billing.
• Strong knowledge of medical terminology and healthcare insurance processes.
• Excellent communication skills for interacting with patients, providers, and insurers.
• Proficient in the use of healthcare management software and Microsoft Office Suite.
• Ability to work independently with precision in a fast-paced healthcare environment.
• Detail-oriented with strong organizational and time management skills to handle multiple tasks.