Prior Authorization Team Lead

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

📋 Description

• Gather and assess documentation necessary for prior and retro authorization requests.

• Analyze payer medical necessity guidelines and authorization prerequisites.

• Interact with practices to gather additional information required for procedure and medication requests.

• Navigate payer portals and oversee communications between providers and clinics to ensure prompt responses.

• Record account activities and uphold precise patient and claim data.

• Track procedures and assist leadership in pinpointing workflow deficiencies.

• Act as a subject matter expert on medical policies, departmental processes, and affiliate workflows.

• Facilitate team meetings, distribute meeting notes, and aid in team training, mentoring, audits, and cross-coverage.

• Assist in the integration of new practices and procedures, including the development of workflows and SOPs.

• Detect authorization trends or issues that could hinder claims processing and propose solutions.

• Collaborate with practices, vendors, insurance carriers, patients, management, and internal teams.

• Deliver exceptional customer service and support across the department.

• Execute other related tasks as assigned.

⛳️ Requirements

• A High School Diploma or GED is required.

• A minimum of one (1) year of prior authorization experience in a clinical environment is necessary.

• Exceptional verbal and written communication skills.

• Strong organizational, analytical, and problem-solving skills.

• Proficient in Microsoft Office Suite or comparable software.

• Comprehensive knowledge of medical policies and LCDs pertaining to pain management procedures.

• Basic familiarity with medical terminology.

• Experience in navigating payer portals to secure authorizations and review medical policies.

🏝️ Benefits

• Health, Dental & Vision Insurance

• Accident and Life/AD&D Insurance

• Short & Long-Term Disability

• Emergency Travel Assistance Program

• ID-Theft Protection Services

• Health Savings Account (HSA)

• Health Management Tools

• Paid Time Off (PTO)

• Company Paid Holidays

• Paternal Leave

• 401(k)

• Remote Stipend

• Travel Reimbursement

• Continuing Education Reimbursement

• Bonusly Employee Recognition Platform

• DailyPay On-Demand Pay Access

• LifeMart Employee Discount Program