Pre-Authorization Specialist I

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

📋 Description

• Conduct research and review medical policies through Policy Reporter, payer websites, and additional payer resources.

• Reach out to health plans to confirm patient insurance eligibility, benefits, and coverage details.

• Initiate and oversee prior authorization requests with health plans and payers.

• Provide updates on the status of prior authorization requests to both internal and external stakeholders.

• Execute benefit investigations to facilitate authorization and billing processes.

• Prepare and present patient cost estimates based on insurance benefits and coverage information.

• Solicit missing information from patients and clients and follow up to acquire necessary documentation.

• Manage communications from clients, patients, and health plans concerning authorization and coverage requests.

• Accurately record prior authorization activities within the specified prior authorization platform.

• Prioritize work tasks based on the urgency of requests and business needs.

• Identify issues related to authorization, eligibility, and coverage, escalating concerns as necessary.

• Perform additional billing-related tasks and other responsibilities as assigned.

• Support reimbursement and revenue cycle operations while ensuring accurate documentation and facilitating timely billing and reimbursement processes.

⛳️ Requirements

• High school diploma with at least 2 years of experience in insurance claims processing, prior authorization, medical benefits verification, or healthcare reimbursement operations.

• Minimum of 2 years of experience documenting healthcare authorization activities in authorization, billing, reimbursement, or revenue cycle management systems.

• At least 2 years of experience utilizing Labcorp systems, including LCLS and/or LCBS.

• A minimum of 2 years of experience in Revenue Cycle Management (RCM) operations.

• One or more years of experience with Microsoft Word, Excel, and Outlook in a healthcare, reimbursement, billing, or authorization setting.

• Strong customer service and customer relations skills.

• Proficient verbal and written communication abilities.

• Time management and workload prioritization capabilities.

• Competence in performing basic mathematical calculations such as addition, subtraction, multiplication, and division.

• Attention to detail in reviewing medical policies, benefits information, authorization requirements, and documentation.

• Ability to collaborate effectively with patients, clients, health plans, and internal teams.

• Ability to escalate concerns related to authorization, eligibility, coverage, and reimbursement according to established protocols.

• Preferred: Associate degree or higher in Healthcare Administration, Business Administration, Health Information Management, or a related healthcare field.

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• Life insurance

• Short-term disability (STD)

• Long-term disability (LTD)

• 401(k)

• Paid Time Off (PTO) or Flexible Time Off (FTO)

• Tuition Reimbursement

• Employee Stock Purchase Plan