Insurance Specialist – Prior Authorization

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

📋 Description

• Manage claims inventory to decrease outstanding accounts receivable.

• Communicate with patients and insurance companies in a professional manner regarding their overdue balances.

• Collect information from patients, clients or family members, clinical areas, government agencies, employers, third-party payors, and medical payment programs, both in-person and via telephone, to register patients, gather or update information, obtain referrals and pre-authorizations, complete necessary forms, conduct evaluations, and assess benefits and eligibility (insurance, public programs, etc.), as well as determine financial responsibility and identify payment sources for services.

• Request, input, verify, and modify patient demographic details, primary care provider, and payor information.

• Deliver exceptional customer service and prompt responses to inquiries and issues related to benefits, billing, claims, and payments.

• Handle phone inquiries and provide service quotes; identify financial resources according to client policies and procedures.

• Utilize various databases and specialized software for revenue cycle tasks including eligibility verifications, pre-authorizations, medical necessity assessments, and patient account updates.

• Clarify charges, respond to questions, and convey a variety of requirements, policies, and procedures regarding patient financial care services and resources to patients, staff, payors, and agencies.

• Collaborate with Claims and Collections to support patients and their families with billing and payment processes.

⛳️ Requirements

• High School Diploma or GED.

• Minimum of 2 years of experience in Denials Management.

• At least 2 years of experience in Medical Billing and Follow-up.

• Experience with Medicare, Medicaid, and commercial payors.

• Familiarity with Workers Compensation Pre-Access.

• Proficient in PC applications including Microsoft Outlook, Word, and Excel.

• Required download speed of 30MB or higher and upload speed of 10MB or higher.

• Must have access to a secure and private workspace (a location where you cannot be overheard or seen, as you may handle protected health information on your screen or verbally mention names, social security numbers, or other PHI).

• Employment eligibility: Must be legally authorized to work in the United States without sponsorship.

• A pre-employment background check is required as a condition of employment.

🏝️ Benefits

• Comprehensive paid training.

• Medical, dental, and vision insurance.

• HSA and FSA options available.

• 401(k) plan with company matching.

• Paid Wellness Time and Holidays.

• Employer-sponsored life insurance and long-term disability.

• Opportunities for internal growth.