Prior Authorization Specialist

This is a fully remote position, open to applicants in Colorado, +5 more states.

📋 Description

• Obtain and confirm prior authorizations within the specified timeframe for procedures, diagnostic tests, and other services.

• Ensure that timely and accurate insurance authorizations are secured before the delivery of services.

• Verify insurance eligibility and understand benefit levels.

• Investigate pre-certification, authorization, and referral requirements.

• Coordinate and provide medical records and letters of medical necessity to payers.

• Collaborate with clinical contacts on cases that necessitate peer-to-peer review.

• Communicate effectively with patients, clinical partners, financial counselors, providers, and insurance representatives.

• Prioritize urgent cases as needed.

• Complete thorough documentation in all applications.

• Adhere to departmental policies and procedures when authorization is not secured prior to the service date.

• Respond to inquiries regarding insurance authorization requirements.

• Manage escalated authorization requests.

• Provide mentorship to team members as required.

• Perform additional duties as assigned.

⛳️ Requirements

• An Associate’s degree in healthcare administration or business administration is preferred.

• A minimum of 3-5 years of experience in a similar role or a related field within a healthcare environment is required.

• Familiarity with medical office operations and billing practices is essential.

• Experience in cardiology is preferred.

• Proficiency in Athena is required.

• Skilled in clinical documentation review to ensure alignment with insurance authorization requirements.

• Compliance with OSHA, HIPAA, and Federal Fraud and Abuse laws and regulations is mandatory.

• Candidates must reside in Colorado, Delaware, Florida, New Hampshire, New Jersey, Pennsylvania, or Texas.

🏝️ Benefits

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Matching 401(k).