Medical Prior Authorization & Insurance Specialist in Dover, Delaware at Access Infusion Care Inc

Infusion Solutions of Delaware (ISD) is seeking a detail-oriented and patient-focused Medical Prior Authorization & Insurance Specialist to join our team. This position is responsible for coordinating insurance authorizations, verifying patient insurance coverage and benefits, completing benefit investigations, and assisting patients with billing and insurance-related questions.

The ideal candidate has strong knowledge of health insurance processes, excellent attention to detail, and the ability to communicate effectively with patients, insurance companies, providers, and internal team members.

Primary Responsibilities

• Obtain and process prior authorizations for medications, infusions, injections, procedures, and other services as required by insurance carriers.
• Submit authorization requests and supporting clinical documentation to insurance companies.
• Monitor authorization status and follow up with insurance carriers as needed.
• Communicate authorization approvals, denials, and additional documentation requirements to appropriate team members.
• Assist with authorization-related denials and determine next steps, including appeals when appropriate.
• Maintain accurate and timely documentation of all authorization activity.
• Verify patient insurance eligibility and coverage prior to services.
• Perform benefit investigations to determine coverage, deductibles, copayments, coinsurance, out-of-pocket requirements, and authorization requirements.
• Maintain accurate insurance information within the practice management/EHR system
• Communicate effectively with providers, clinical staff, billing staff, patients, and insurance representatives.

Qualifications

• Previous experience in medical billing, insurance verification, prior authorization, revenue cycle, or a related healthcare setting preferred.
• Knowledge of CPT, HCPCs and ICD-10-CM Codes
• Strong attention to detail and ability to identify discrepancies.
• Ability to manage multiple priorities and meet deadlines.

· Comfortable communicating with insurance representatives and patients by phone.

Benefits

• Medical, dental, and vision insurance
• 401(k) retirement plan
• Paid time off
• Paid holidays
• No nights, weekends, or major holidays
• Stable, professional outpatient medical-office environment
• Consistent daytime schedule
• Excellent Salary