Prior Authorization Representative
Networks Connect - Silver Spring
Work at Networks Connect
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Overview
Job description
Join Our Team as a Prior Authorization Representative
Networks Connect is conducting a search on behalf of our client, a prominent local Healthcare System. We are looking for a detail-oriented Prior Authorization Representative to support patient access by managing insurance verification, prior authorizations, and referral processes. This role plays a critical part in ensuring smooth patient care by reducing payor-related barriers and enhancing financial outcomes.
Why Join Us?
- Competitive salary and comprehensive benefits
- Growth opportunities within the healthcare industry
- Supportive and collaborative team environment
- Meaningful work that directly impacts patient care
Responsibilities:
- Manage pre-service payor clearance, ensuring prior authorizations and insurance verification are completed before services are provided
- Work with referring physician offices, insurance carriers, and patients to navigate prior authorization requirements
- Verify insurance eligibility, secure referrals, and ensure proper documentation for claims processing
- Address and resolve any insurance coordination of benefits (COB) issues before services are rendered
- Assist in obtaining approvals for add-on cases and update authorizations as needed
- Provide clinical information to insurance payors to streamline authorization approvals and minimize peer-to-peer reviews
- Educate providers and staff on payor guidelines and documentation requirements
- Track and report trends related to denials, appeals, and authorization approvals to improve efficiency
- Collaborate with internal departments, including Compliance, Patient Financial Services, and Case Management, to reduce claim denials
Qualifications:
- Education: High School Diploma or GED required; Associate or Bachelor's degree in healthcare or business-related field preferred
- Experience: Minimum 2 years in healthcare registration, billing, insurance verification, prior authorization, or claims processing
Skills:
- Strong knowledge of medical and insurance terminology, including CPT and ICD coding
- Excellent communication and customer service skills
- Ability to multitask and problem-solve in a fast-paced environment
- Proficiency with Electronic Medical Records (EMR) systems preferred
- Bilingual candidates are a plus
- Type 35+ WPM
Benefits:
- Competitive salary with performance incentives
- Health, dental, and vision insurance
- Paid time off and holidays
- Career advancement opportunities
- A positive and inclusive work environment
Apply today to become a vital part of our Client’s healthcare team!
Job Type: Full-time
Pay: $45,000.00 - $55,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Disability insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Parental leave
- Retirement plan
- Tuition reimbursement
- Vision insurance
Work Location: In person