Pre-authorization/clinical Reviewer

Key Responsibilities:- Review and evaluate preauthorization requests for medical procedures within a large surgical center.- Ensure that all preauthorization documentation is complete, accurate, and in compliance with established medical guidelines and protocols.- Collaborate with healthcare providers, physicians, and other stakeholders to obtain additional information or clarification as needed.- Conduct benefit reviews to determine insurance coverage for proposed medical procedures.- Communicate with insurance companies to obtain preauthorization approvals and address any denials or discrepancies.- Maintain accurate and detailed records of preauthorization requests, approvals, and denials.- Stay updated on changes in insurance policies, medical guidelines, and industry regulations affecting preauthorization processes.- Provide guidance and education to healthcare providers and staff on preauthorization requirements and best practices.- Work closely with billing and coding teams to ensure accurate and timely processing of preauthorized procedures.- Participate in continuous quality improvement initiatives to enhance the efficiency and effectiveness of the preauthorization process.Qualifications and Requirements:- Clinical background, preferably with a degree in nursing or a related field.- Proven experience in a preauthorization or utilization review role, specifically within a large surgical center.- In-depth knowledge of medical procedures, terminology, and documentation requirements.- Familiarity with insurance benefit reviews and the preauthorization process.- Strong communication and interpersonal skills to effectively collaborate with healthcare providers, insurance companies, and internal teams.- Detail-oriented with excellent organizational and time-management skills.- Ability to work independently and make informed decisions in a fast-paced environment.- Proficient computer skills, including experience with electronic health records (EHR) and preauthorization software.- Knowledge of relevant healthcare regulations and compliance standards.**Who we are**Our mission is to provide high-quality, accessible, and affordable surgical care solutions. IBI Healthcare Institute is a surgical group devoted to providing the highest quality healthcare services. Our vision is to become the most respected and successful surgical group in the United States for our patients, members, and partners. At IBI Healthcare Institute we are experts in incision-less acid reflux treatment surgery and are one of the leading experts on weight loss surgery in Georgia.**Why IBI Healthcare Institute?**IBI Healthcare Institute improves our patients’ lives through personalized care, exceptional service, and leading-edge treatments. You’re talented and dedicated to high-level patient care. You’ll choose IBI Healthcare Institute because you want to work with people who are compassionate, welcoming, friendly, smart, energetic, and dedicated to providing excellent healthcare. As we change the face of medical management within Physician Group Practices, we’re providing our team members with a friendly, team-oriented culture**Because**- Fastest growing Surgical practice in the Southeastern United States- The staff works well together. Excellent supportive team environment.- Work alongside multiple physicians, clinical leaders, and staff. There is never a dull moment here.- Your work will be noticed and recognized.We’re an equal-opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.**Experience**:- Preauthorization Review: 2 years (required)- Healthcare: 1 year (preferred)**Language**:- Spanish (preferred)License/Certification:- PACS (preferred)Work Location: Remote