Prior Authorization Specialist; Procedures

Position: Prior Authorization Specialist (Procedures)
About Us
At Next Dimension AI, our mission is to simplify healthcare. We are a technology company building the next generation of AI-powered systems to automate complex workflows and create a more responsive, patient-centric experience. We have bold ambitions to reimagine healthcare, setting a new standard for how care is delivered and experienced across the industry. Our growing suite of AI solutions spans the Front Office, Clinical Operations, and Revenue Cycle Management.
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Healthcare's moment for AI-powered transformation is here, and we're building the technology to power it. Come join us in shaping the future of healthcare.

Role Description
As a Prior Authorization Specialist for Procedures, you will be a crucial link between our patients, our clinical team, and insurance carriers. Your primary responsibility will be to secure financial clearance for all office-based and hospital-based gastroenterology procedures, such as endoscopies, colonoscopies, and capsule endoscopies. You will manage a high volume of authorization requests, meticulously track their status, and ensure all necessary approvals are in place before the patient's scheduled service.

Key Responsibilities:

Verify patient insurance eligibility and benefits for all scheduled GI procedures.
Initiate, submit, and diligently follow up on prior authorization requests through insurance portals, phone, and fax.
Gather and attach required clinical documentation (physician notes, lab results, imaging reports) to justify medical necessity.
Communicate effectively with physicians, nurses, and scheduling staff regarding the status of authorizations.
Document all activities and outcomes accurately in the patient's electronic health record (EHR).
Address and resolve initial authorization rejections or requests for additional information.

Qualifications:

Minimum of 2 years of experience in medical prior authorizations, specifically for surgical or medical procedures.
Strong understanding of CPT (procedural) and ICD-10 (diagnostic) codes is required.
Demonstrated experience navigating the portals of major medical insurance carriers (e.g., United Healthcare, Aetna, Cigna, BCBS).
Ability to read and interpret clinical documentation to extract information supporting medical necessity.
Excellent organizational skills and the ability to manage a large caseload with competing deadlines.
Experience in gastroenterology or surgical practice is highly preferred.