Medical Pre-Authorization Clerk

Job Summary

The Medical Pre-Authorization Clerk role is a dynamic position on the front lines of serving our patients that requires multi-tasking, communication, and teamwork. We are a very busy practice and are looking for someone who is a fast learner, detail-oriented, can work under pressure, and will be a valued addition to our team. COVID-19 vaccination required.

Responsibilities and Duties

• Calls insurances and pharmacies for pre-authorizations and schedules peer-to-peers, as necessary.
• Verify coverage, benefits and eligibility for the patient with insurance company
• Pre-Cert / authorization for upcoming surgeries with insurance company
• Obtains clinical information required for review and documentation of precertification requests and routes to the appropriate individuals for processing.
• Monitors e-fax, fax machines, and mail for authorization/re-authorization requests and routes information timely to the appropriate individuals for processes.
• Answers inquiries from patients and providers and routes to appropriate physician.
• Communicate authorization information to patients accurately and in a timely manner.
• Effectively resolves inquires related to status of authorization requests.
• Provides accurate and timely documentation to physicians for peer-to-peer consultation.
• Use hospital or provider systems to locate appropriate patient details.
• Respond to requests with the corresponding health information.

Qualifications and Skills

• Previous pre-authorization experience required
• Previous medical office experience - strongly preferred
• Knowledge of medical terminology - strongly preferred
• Knowledge of HIPAA - required
• Provide excellent customer service, including compassion, ability to assess situations, identify concerns, and give timely follow up
• Display a courteous and professional manner through interaction, appearance, attitude, and with written and oral communication with patients, third parties, co-workers, and physicians
• Ability to protect and maintain the confidentiality of patient’s medical records and patient information, handling patient information with discretion and integrity
• Ability to work efficiently in a fast paced, unpredictable (at times) environment
• Strong organizational skills, time management, and multi-tasking abilities
• Meticulous attention to detail
• Proficient data entry skills
• Strong computer skills, with ability to quickly master new systems and software, including EMR
• Must be able to effectively use office technology, such as fax, copier, and scanner
• High school graduate – required

Required experience:

• Medical office pre-authorizations/clinical/records administration: 2 years required

Required education:

• High school

Required work authorization:

• Authorized to work for any employer in the United States