Medical Authorizations Clerk - temp to perm

FlexStaff is seeking a temp to perm Medical Authorizations Clerk for our client, a medical practice located in Port Jefferson, NY.

The Medical Authorizations Clerk is responsible for obtaining prior authorization approvals from insurance companies for patient infusions, medications, and medical/radiology tests.

• Monday-Friday, 8-4:30pm or 8:30-5pm
• Port Jefferson, NY
• Rate: $23-25/hr
• Temp to Perm

Responsibilities:

Insurance Verification and Authorization

• Initiate and manage the authorization process for medications, infusions, and medical tests, ensuring accurate and timely submission of requests to insurance providers.
• Work closely with physicians, nurses, and healthcare teams to obtain the necessary medical documentation required by insurance companies for approvals.
• Follow up on authorization requests to ensure timely approval, working with insurance representatives to resolve any issues or discrepancies.
• Monitor the status of all outstanding authorizations and ensure that approvals are received in advance of scheduled procedures or treatments.

Insurance Communication

• Communicate effectively with insurance companies to obtain clarification on policy guidelines, coverage criteria, and approval requirements for specific treatments, medications, and testing.
• Document all communications and interactions with insurance companies, healthcare providers, and patients, ensuring accurate records are maintained for future reference.
• Provide status updates to patients, healthcare providers, and internal team members regarding the progress of authorization requests.

Patient and Provider Support

• Assist patients in understanding their insurance coverage and any required out-of-pocket costs, including co-pays or deductibles, for approved treatments and medications.
• Work with healthcare providers to gather necessary clinical information and documentation to ensure authorization requests are complete and properly substantiated.
• Address any issues or delays in the authorization process, helping patients and providers resolve concerns quickly and efficiently.

Compliance and Documentation

• Ensure all authorizations are compliant with insurance policies, industry standards, and regulatory requirements.
• Maintain thorough and accurate documentation of all authorization activities, including the submission and approval process, for auditing and compliance purposes.
• Stay up to date with changes in insurance policies, guidelines, and regulations related to medical treatments, medications, and testing.

Appeals and Denial Management

• Review and analyze denied authorization requests, working with healthcare providers to appeal denials or re-submit information as necessary.
• Track and document the appeals process, ensuring that all required information is provided to insurance companies in a timely manner.

Qualifications

• High school diploma or equivalent (Associate's degree or healthcare-related certification is a plus).
• Previous experience in medical insurance authorizations, medical billing, or healthcare administration is preferred.
• Knowledge of medical terminology, insurance processes, and healthcare regulations (especially regarding authorizations and approvals).
• Familiarity with insurance systems and healthcare software (e.g., EMR, billing systems).
• Strong communication skills, both verbal and written, with the ability to interact effectively with insurance companies, healthcare providers, and patients.
• Detail-oriented with strong organizational skills and the ability to manage multiple tasks simultaneously.
• Ability to work independently and as part of a team in a fast-paced environment.

Occasional overtime may be required to handle high-volume authorization requests or urgent cases.

*Additional Salary Detail

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).