Prior Authorization Specialist

Enhanced Revenue Solutions by Infinx is currently hiring for a Prior Authorization Specialist in our Spring, Texas office. Come join our team and be a part of one of the most successful revenue enhancement teams in the nation.

Duties and Responsibilities

  • Obtain timely prior authorization/ prior- determination/ or prior – certification from all insurances, that require based upon plan or insurance contract, following the company established policies and protocols.
  • Select accurate medical records for patient safety and obtaining and validating demographic and insurance information.
  • Provide all required medical information to insurance companies as necessary to facilitate the authorization process.
  • Follow up in timely manner on insurance determinations regarding submitted requests.
  • Run system generated reports to verify procedures by insurances requiring authorization are being captured.
  • Must request, obtain, and document (within current software) all prior authorizations (or denials of same) appropriately and in a timely manner.
  • Maintain and update internal listing of insurance carriers that require authorization and their processes.
  • Obtain retro authorizations as needed.
  • Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements.
  • Perform related work as required.

Required Education, Training and Experience

  • High School Diploma
  • Knowledge of Medical Terminology and ability to interpret clinical documentation
  • Good understanding of ICD10, CPT codes, can HCPCS codes
  • Good understanding of third-party reimbursement procedures for all type of insurance plans, including governmental, commercial and Workers Compensation
  • Computer literacy and proficient in using Microsoft Office
  • At least 1+ years of experience in getting prior authorizations for the Specialists, preferably with Orthopedics, Cardiology, Imaging procedures.

This individual must have good organizational skills as well as excellent telephone, written and verbal communication skills. (S)he must project a professional image and work well with the general public and co-workers. Must be able to work as a team member.

Salary Range is dependent on level of experience
Job Type: Full-time
Pay: $17.00 – $19.00 per hour

To apply, email your resume to hr@enhancedrevenuesolutions.com

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