RCM Authorizations Representative

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

📋 Description

• Examine EHR task lists to ascertain authorization needs for commercial surgeries, physical therapy, MRI/CT scans, injections/VISCO, and DME/bone stimulators.

• Review orders and essential dictations within the EHR system.

• Ensure authorization lists are current so that requests are dispatched promptly.

• Document interactions and update orders as new status information becomes available.

• Inform providers, coordinate Peer to Peer requests, and follow up on results.

• Update clinical and radiology staff regarding changes in authorization requirements.

• Act as a primary contact for outsourced authorization firms and uphold contractual turnaround times.

• Communicate scheduling requirements with the Director of Operations, Office Managers, and PCCs.

• Serve as a resource and initial point of contact for procedural and workflow challenges.

• Keep staff updated on changes to procedures and workflows.

• Manage the authorization team task list.

• Maintain a professional environment with patients, physicians, colleagues, and administration.

• Collaborate directly with RCM and operational teams to ensure proper scheduling and patient care.

• Oversee team communication and decision-making processes.

• Accurately and confidentially create, update, and access sensitive patient data in the EMR.

• Act as the primary contact for provider communications and patient concerns.

• Prioritize tasks and manage multiple responsibilities effectively.

⛳️ Requirements

• A minimum of one year of experience in prior authorization is required.

• Familiarity with orthopedic procedures is advantageous, but not mandatory.

• Exceptional telephone etiquette is essential.

• Strong written and verbal communication skills are required.

• Proficiency in computer systems is preferred, including practice management software, EMR, Microsoft Word, and Excel.

• Attention to detail and strong organizational skills are preferred.

• High school diploma or equivalent is required.

• Knowledge of Local Coverage Insurance Plans is a plus.

• No travel is necessary.

🏝️ Benefits

• Excellent opportunities for growth and advancement.

• A dynamic work environment.

• Access to a diverse network of practitioners.

• A comprehensive array of tools and programs to enhance the employee experience.

• Competitive compensation package.

• Generous paid time off (PTO).

• Health, dental, and vision insurance benefits.

• 401(k) retirement plan.