Prior Authorization Specialist

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

📋 Description

• Oversee the Prior Authorization queue and maintain a well-organized record of outstanding and in-progress prior authorizations.

• Assess patient and service information provided by the biller and clinical team to ensure completeness and accuracy.

• Efficiently submit new prior authorizations to the appropriate insurance company and plan using the required methods, such as insurance portals, fax, or telephone.

• Actively and consistently contact insurance companies to inquire about the status of submitted prior authorizations to avoid processing delays.

• Clearly and promptly document all communication and status updates in the patient management system.

• Identify, prepare, and submit appeals for prior authorization denials in a timely manner, collecting all necessary clinical and administrative documentation.

• Monitor the status of all submitted appeals until resolution is achieved.

• Regularly check the designated fax inbox or electronic queue for notifications regarding prior authorization approvals, denials, and requests for additional information.

• Immediately update the patient management system with the final PA status, authorization number, and expiration date upon receiving approval.

⛳️ Requirements

• Exceptional Attention to Detail: Vital for accurately submitting data and preparing appeals.

• Strong Communication Skills: Excellent verbal and written communication abilities necessary for professional interactions with insurance representatives and clinical staff.

• English Speaking: Fluency in English is essential for effective communication with insurance representatives and team members.

• Organizational and Time Management Skills: Capacity to prioritize a large volume of PA requests and follow-up tasks within deadlines.

• Problem-Solving: Resourceful in addressing issues with insurance company portals or processes.

• Team Player: Ability to collaborate effectively with billing and clinical teams to meet patient care objectives.

• Medical billing experience (optional)

• Familiarity with various commercial and government payer systems (e.g., Medicare, Medicaid, and major commercial insurers) (optional)

• Proven knowledge of medical terminology, CPT codes, and ICD-10 codes (optional)

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and growth.

• Supportive work environment that values teamwork and collaboration.

• Flexible working hours to promote work-life balance.