Insurance, Prior Authorization Specialist

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

📋 Description

• Act as a subject matter expert in the areas of insurance billing, claims processing, and prior authorizations.

• Serve as a liaison between departments, payors, and providers to assess the overall prescription coverage for patients.

• Offer expertise in verifying medical and prescription insurance coverage, billing claims, processing medication prior authorizations, filing appeals, and exploring alternative financial assistance options.

• Accurately record information in the required systems and formats.

• Communicate the status of referrals to physicians and patients through phone, fax, and/or the core pharmacy system.

• Support offices in the documentation and filing processes for prior authorizations and appeals.

• Track authorization and appeal statuses to facilitate swift turnaround and acquisition of drug products.

• Utilize internal and web-based tools to analyze pharmacy and medical benefits.

• Work collaboratively with health insurance payors and providers while maintaining resources for payor intelligence.

• Input patient demographic and health insurance details into the hub information system.

• Inform physicians of any incomplete or erroneous insurance information.

⛳️ Requirements

• 1–3 years of relevant work experience within a healthcare or reimbursement context.

• Required prior experience in a call center, healthcare office, corporate environment, healthcare insurance provider, or pharmacy setting.

• Comprehensive understanding and knowledge of commercial and governmental pharmacy and medical insurance programs.

• Familiarity with billing processes, alternative funding resources, reimbursement procedures, insurance verification, prior authorization and appeal submissions, as well as specialty pharmacy operations.

• Experience in a pharmacy call center is a plus.

• Background in healthcare call centers and medical claims is an advantage.

🏝️ Benefits

• Medical, dental & vision coverage.

• Critical Illness, Accident, and Hospital insurance options.

• 401(k) Retirement Plan offering pre-tax and Roth post-tax contributions.

• Life Insurance (Voluntary Life & AD&D for both employee and dependents).

• Short- and long-term disability coverage.

• Health Spending Account (HSA).

• Transportation benefits.

• Employee Assistance Program.

• Paid Time Off/Leave (PTO, Vacation or Sick Leave).