Authorization Coordinator
14 hours ago
The Prior Authorization Specialist position is responsible for ensuring seamless prior authorization processes, encompassing a range of tasks including biologic medication, procedures, and outpatient testing.
This role requires effective communication and collaboration with patients, pharmaceutical representatives, healthcare providers, pharmacies, and insurance carriers to obtain accurate information and facilitate timely processing of prior authorizations.
Key Responsibilities:
- Prior Authorization Processing: Review and process prior authorization requests for medical services, procedures, and medications in accordance with established guidelines.
- Insurance Verification: Verify patient insurance information and eligibility to ensure accurate billing and reimbursement.
- Patient Interaction: Handle patient inquiries regarding prior authorizations and provide necessary documentation for completion and signature.
- Documentation and Communication: Accurately document all patient, pharmacy, and insurance carrier interactions in the electronic medical record (EMR) and communicate effectively with healthcare providers and insurance companies.
- Authorization Management: Ensure timely and accurate documentation of authorization requests and approvals, as well as coordinate with the medical billing team to resolve any issues or denials.
- Knowledge and Skills: Maintain up-to-date knowledge of insurance guidelines, procedures, and regulatory requirements.
- Additional Tasks: Complete other assigned tasks through the EMR/EHR system, which may include scheduling appointments, copying, faxing, and mailing documents, and assisting pathology departments with notifying patients of results via telephone.
- Professional Development: Participate in ongoing training and professional development to enhance skills and knowledge in areas such as insurance verification, billing, and patient communication.
Requirements:
- Proven experience as a Prior Authorization Specialist in the US Healthcare industry, preferably with 3-5 years of experience.
- Strong knowledge of insurance verification processes, payer/billing guidelines, and regulatory requirements.
- Excellent communication and interpersonal skills, with the ability to work effectively with diverse stakeholders, including patients, providers, and insurers.
- Detail-oriented with strong organizational skills, able to prioritize tasks and manage multiple projects simultaneously.
- Ability to work independently and meet deadlines, with flexibility to adapt to changing priorities and workflows.
- Amenable to working in a remote, work-from-home setup and comfortable working non-traditional hours, including graveyard shifts.
System Requirements:
- Device Specifications:
- Processor: Intel Core i5 (or higher) or AMD Ryzen 5 (or higher).
- RAM: Minimum of 8GB or higher for optimal performance.
- Operating System: Windows 11 Pro (Windows 10 Pro is acceptable but not preferred), with a legitimate license.
- Hard Disk: At least an SSD for faster processing and performance.
- Internet Connectivity: Minimum speed of 50 Mbps via a wired connection for stability and reliability, with a backup internet connection recommended.
- Power Supply: A backup power supply (e.g., UPS or generator) to prevent disruptions during power outages (optional but encouraged).
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