Authorization and Verification Research Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct research and document the requirements for prior authorization and benefit verification across various payors, including commercial plans and state Medicaid programs.

• Examine submission processes specific to each payor, including required documents, portals, fax numbers, CPT code stipulations, and updates to policies.

• Keep abreast of changes in payor policies, particularly those that impact authorization procedures and benefit structures.

• Utilize payor websites, newsletters, and communications from representatives to collect accurate and current information.

• Verify information from diverse sources and assess the credibility of guidance provided by payors.

• Operate independently to resolve ambiguous issues where established procedures have not yet been developed.

• Clearly communicate findings to cross-functional teams and swiftly adjust to feedback.

• Manage tight deadlines and adapt to shifting priorities in a dynamic startup atmosphere.

⛳️ Requirements

• Experience with prior authorization and/or insurance verification in a healthcare clinic setting.

• Extensive knowledge of payor submission processes and an understanding of how requirements differ among various insurance plans.

• Strong research capabilities and proficiency in navigating payor portals, websites, and related documentation.

• Exceptional attention to detail with the ability to identify common authorization errors.

• Experience interacting with multiple payors and comprehending variations in processes.

• Proven ability to develop or enhance processes in the absence of established protocols.

• A resilient problem-solver who flourishes in ambiguous and changing environments.

• Excellent communication skills and the ability to seek assistance when necessary.

• A humble attitude and a willingness to learn from experiences.

🏝️ Benefits

• Fully remote work environment.

• All required devices and system access will be provided.