Pre Authorization Specialist II

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

📋 Description

• Perform benefit investigations and assess payer medical policies.

• Initiate and oversee prior authorizations.

• Offer patient cost estimates.

• Address high-volume billing tasks and inquiries via phone, chat, email, and portal communications.

• Review incoming orders for completeness and accuracy of prior authorization documentation.

• Collaborate with vendors to ensure successful submissions of prior authorizations.

• Track the status of prior authorization requests and follow up on pending cases.

• Stay current on insurance policies and guidelines.

• Keep precise records of authorization requests, approvals, and denials in databases.

• Work with team members to establish best practices and enhance service quality.

• Identify challenges and propose potential improvements.

• Adhere to assigned schedules and adjust to shifting business needs.

• Engage in projects that extend beyond daily responsibilities.

• Provide professional support to providers, patients, and insurance representatives concerning prior authorization status and requirements.

• Collaborate with patients, health plans, clients, and internal stakeholders to fulfill authorization and coverage requirements, facilitating timely billing and reimbursement.

⛳️ Requirements

• High school diploma with 3 or more years of relevant experience.

• Associate degree or higher in Healthcare Administration, Business Administration, Health Information Management, or a related healthcare field (preferred).

• 2 or more years of experience documenting healthcare authorization activities within authorization, billing, reimbursement, or revenue cycle management systems (preferred).

• 2 or more years of experience with Labcorp systems, including LCLS and/or LCBS (preferred).

• 2 or more years of experience in Revenue Cycle Management (RCM) operations (preferred).

• 1 or more years of experience using Microsoft Word, Excel, and Outlook in a healthcare, reimbursement, billing, or authorization context (preferred).

• Capacity to work remotely from a private, quiet workspace.

• Dependable high-speed internet connection (minimum 50 Mbps).

• Proficiency in Microsoft Office (Word, Excel, Outlook).

• Strong customer service, time management, and organizational abilities.

• Excellent verbal and written communication skills.

• High attention to detail with the capacity to manage multiple priorities.

• Solid understanding of medical terminology, insurance guidelines, and healthcare regulations.

• Self-motivated, collaborative, and proactive.

• Strong work ethic, adaptability, and commitment to fostering positive patient outcomes.

• Problem-solving skills in a fast-paced, team-oriented, and evolving environment.

🏝️ 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.