Prior Authorization Specialist

This is a fully remote position, open to applicants in Arizona, +17 more states.

📋 Description

• Secure precise prior authorizations for facility and professional charges associated with scheduled patient visits.

• Submit CPT and HCPCS codes along with medical records to insurance providers to facilitate authorization requests.

• Verify patient demographics and medical data while ensuring compliance with HIPAA regulations.

• Assess the accuracy and completeness of information and validate supporting documentation.

• Collaborate with relevant stakeholders effectively.

• Prioritize incoming authorization requests in accordance with departmental procedures.

• Confirm the accuracy of CPT and ICD-10 diagnosis codes in procedure orders.

• Maintain intranet resources pertaining to payer requirements.

• Reach out to patients and/or clinics if authorization is not secured prior to the service date.

• Initiate retro authorization requests and address authorization denials.

• Prepare, submit, and monitor appeals.

• Document all actions taken within patient accounts.

• Communicate issues related to billing, authorization, insurance, backlog, problematic accounts, and documentation to leadership.

• Adapt to evolving circumstances to facilitate patient flow.

• Uphold professionalism, integrity, confidentiality, and accurate attendance.

⛳️ Requirements

• At least two (2) years of experience in an acute care hospital, specialty clinic, and/or medical billing office focused on obtaining pre-certifications and/or prior authorizations.

• Familiarity with commercial and government insurance requirements.

• Understanding of medical terminology and regulations governing the handling of private health information.

• Proficient in ICD-9 and CPT coding.

• Comprehension of reimbursement and claims processes and their direct effect on the revenue cycle.

• Proficient with Microsoft Office Suite and the capability to learn additional software as necessary.

• Exceptional verbal and written communication skills in English.

• Strong organizational abilities, attention to detail, critical thinking, and the capacity to prioritize effectively.

• Ability to work independently as well as collaboratively within a team.

• Excellent interpersonal skills with the ability to handle sensitive and confidential situations with tact, professionalism, and diplomacy.

• Must reside in Arizona, Arkansas, Colorado, Florida, Hawaii, Idaho, Illinois, Indiana, Kansas, Michigan, Missouri, Montana, Minnesota, North Carolina, Ohio, Oregon, Tennessee, Texas, Virginia, or Washington.

• An Associate or Bachelor’s degree is preferred.

• Experience with Meditech is preferred.

• Knowledge of managed care coverage and medical coding is preferred.

🏝️ Benefits

• Comprehensive benefits package.

• Opportunities for career advancement.

• Full-time remote work options.

• Pre-employment screening includes criminal background check, reference checks, drug screening, health and immunization screenings, and physical demand assessments.