Prior Authorization Specialist

Description

• Maintain a working knowledge of payer program requirements and networks
• Verifying patients insurance eligibility and benefits
• Knowledge of CPT and ICD-10 coding
• Obtain prior authorization and/or referrals for patient encounters/procedures
• Communicates with providers to ensure high value patient experience
• Securing patient responsibility prior to services
• Managing charity care and discount requests
• Processes correspondence relating to insurance information or questions
• Performs necessary follow-up to resolve rejected claims, resubmissions and other insurance inquiries
• Assists as needed in processing insurance payments so that all accounts are up to date and accurate
• Responds promptly and accurately to patient inquiries or complaints
• Helps to identify opportunities for improvement in departmental processes, procedures and workflows
• Other duties as assigned.

Requirements

BASIC QUALIFICATIONS

• High School Diploma or GED Required
• Excellent written and verbal communication skills
• Previous Prior Authorization experience preferred

Midwest Culture

As a physician-owned practice serving our community for over 110 years, we are committed to respecting every person, acting with integrity, and owning our outlook. We provide our employees with a comfortable and productive work environment that is patient focused, and relationship-based. We take responsibility for reinforcing the strength, health, and safety of the communities in which we work and live.

Mentorship & Career Growth
At Midwest ENT, we are deeply committed to the growth and success of our team members, particularly those who are new to our organization. We take pride in fostering a collaborative environment that embraces individuals with varying levels of experience and tenure. We have a focus on knowledge sharing and mentorship, enabling everyone to learn, grow, and excel together. We believe in the power of teamwork and are dedicated to supporting and empowering each member of our team.

Work/Life Balance
At Midwest, we place a high value on work-life balance. We offer a consistent Monday-Friday schedule from 8 am to 5 pm with paid holidays and a flexible time off policy to prioritize your well-being. Our goal is to foster a supportive environment where you can thrive both personally and professionally. 

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment.