Prior Authorization Specialist I

This is a remote position.

• Verify insurance coverage and eligibility
  
• Interpret physician orders, medical terms and insurance details to process authorizations
  
• Contact providers as necessary, gathering clinical information needed for insurance providers
  
• Partner with Billing to accurately code services to ensure expedient approvals and payments
  
• Obtain insurance authorizations via telephonic and online payer systems
  
• Secure medical necessity checks in accordance with Medicare, Medicaid, and private payer guidelines
  
• Partner with clinicians to complete patient registration, educating patients on financial liabilities - working cross functionally
  
• Perform online data entry of routine authorizations and denials
  
• Other admin duties as assigned
  

Requirements

• 1+ years experience in a customer service role required
  
• 1+ years of remote work experience required
  
• Prior Authorization Specialist 2
  
• 1-2 years of experience in a similar role preferred
  
• With experience using JIRA Service Desk and Zendesk
  
• Familiarity using various systems for eligibility checks such as Availity and Insomniapreferred
  
• Ability to work in a fast paced environment and pivot as needs change
  
• Knowledge of function and relationships within hospitals or medical offices preferred
  
• Understanding of third party payor requirements preferred
  
• Must be able to complete job duties while seated at desk for multiple hours
  
• Must have Fiber Optic internet with at least 25 Mbps bandwidth
  
• Must have a backup desktop or laptop with the latest OS
  
• Must be able to work from 10PM-7AM
  
• Must be amenable to work in-office
  

Benefits