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Prior Authorization Management Jobs in Ohio (NOW HIRING)

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Prior Authorization Management information

What is the difference between Prior Authorization Management vs Medical Billing Specialist?

AspectPrior Authorization ManagementMedical Billing Specialist
CredentialsKnowledge of insurance policies, healthcare regulationsMedical coding certifications, billing software proficiency
Work EnvironmentHealthcare providers, insurance companiesMedical offices, billing companies
Industry UsageHealthcare administration, insurance processingMedical revenue cycle management
Primary FocusSecuring approval for treatments and proceduresProcessing and submitting medical claims for payment

While both roles are essential in healthcare administration, Prior Authorization Management focuses on obtaining approvals for treatments, whereas Medical Billing Specialists handle the billing and claims process. Understanding these differences helps healthcare organizations optimize their revenue cycle and ensure patient care continuity.

Are prior authorization management jobs in high demand?

Prior authorization management jobs are in steady demand due to the increasing complexity of healthcare billing and insurance requirements. These roles often require knowledge of healthcare policies, attention to detail, and familiarity with electronic health record systems, making them a stable career option in the healthcare administration field.

Is prior authorization management a stressful job?

Prior authorization management can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. The role often involves handling complex insurance policies and communicating with healthcare providers, which can contribute to workload pressure. However, stress levels vary depending on the work environment and individual coping strategies.

What career paths follow prior authorization management?

Prior authorization management roles can lead to careers in healthcare administration, insurance claims processing, compliance, or healthcare consulting. Professionals often advance to supervisory or managerial positions, or specialize in areas like medical billing, coding, or healthcare policy, leveraging skills in documentation, regulations, and healthcare systems.

What cities in Ohio are hiring for Prior Authorization Management jobs?

Cities in Ohio with the most Prior Authorization Management job openings:

Prior Authorization Management jobs near you

Pharmacy Prior Authorization Specialist

Broadview Heights, OH • Remote

Communicarehealth
Health Care and Social Assistance • 10K+ employees
Learn more about Communicarehealthexternal

$17.50 - $23.25/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 27 days ago

Communicare Health Services rating

6.1

Company rating: 6.1 out of 10

Based on 158 frontline employees who took The Breakroom Quiz

Job description

Job Address:

9299 Market Place Broadview Heights, OH 44147


Job Description: Prior Authorization Specialist

Reports to: Pharmacy Prior Authorization Manager

Job Type: Full-Time - Remote - Pharmacies: West Virginia, Ohio, Indiana and Maryland

Position Overview: The Prior Authorization Specialist will maintain the Prior Authorization's workflow for a set of facilities assigned by the supervisor, while providing customer service to clients. He/she wil enter required information and submit Prior Authorizations to the respective plan, follow the prior authorization to completion, identify and clarify any discrepancies with a prior authorization, and participate in the appeal process.

Key Responsibilities Include but are not limited to:

  • Work in cohesion with the Adjudication, Claim Intervention and Billing Departments
  • Submit prior authorizations in accordance with Insurance regulations
  • Ensure accurate and timely processing of prior authorizations
  • Work directly with insurance companies for prior authorization resolution
  • Communicate with facilities to gain additional information
  • Any other duties assigned
  • Follow federal and state regulations
  • Adhere to company policies and procedures
  • Follow HIPPA guidelines and regulations

Qualifications and Requirements:

  • Prior Authorization experience (not required)
  • Previous Long-Term Care pharmacy experience a plus (not required)
  • Knowledge of Framework LTC a plus (not required)

Salary and Benefits:

  • Competitive salary commensurate with experience
  • Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more

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