Prior Authorization Specialist

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

📋 Description

• Review and address prior authorization inquiries in Salesforce.

• Investigate accounts that need appeals for denied prior authorizations.

• Prepare and send appeals to insurance companies, including necessary medical records, documentation, and justification.

• Analyze and resolve rejected authorizations.

• Communicate with healthcare providers and insurance companies to enable peer-to-peer review.

• Submit and monitor prior authorization requests utilizing the appropriate systems and tools.

• Ensure that documentation is thorough and precise to prevent delays in authorizations.

• Track the outcomes of appeals and follow up on any unresolved cases.

• Collaborate with clinical teams, billing departments, market access, and insurance representatives.

• Provide regular updates to management regarding authorizations and appeals.

• Stay updated on insurance guidelines and payer requirements.

• Liaise with both internal and external stakeholders.

• Perform additional tasks as assigned.

⛳️ Requirements

• 3-5 years of experience in healthcare billing, particularly in prior authorizations and appeals.

• Strong knowledge of insurance policies, medical terminology, and coding practices.

• Familiarity with insurance authorization and verification procedures for major health plans.

• Excellent communication and interpersonal skills.

• Proficiency in Google Apps, Mac OS X, and CRM applications.

• Understanding of HIPAA regulations pertaining to healthcare.

• Experience with Xifin, SalesForce, and Careviso is advantageous.

• Ability to work during EST hours.

• Outstanding attention to detail and organizational skills.

• No specific certificates, licenses, or registrations are required.

• High school diploma is preferred.

🏝️ Benefits

• Competitive compensation and benefits aligned with local market practices and legal requirements.

• Fully remote work opportunity from a home office or another appropriate remote location.

• Flexible scheduling and hours arranged in collaboration with leadership and adjusted to meet business needs.

• Reasonable accommodations available for individuals with disabilities.