WFH Medical Insurance Verification and Prior Authorization Assistant

This is a remote position.

Job Highlights:

• Contract type: Independent Contractor
• Night Shift Schedule:Monday to Thursday - 8:45am to 5pm New York Time (8:45pm - 5am Manila Time)
• Friday - 8:45am to 3:45pm New York Time (8:45pm - 3:45am Manila Time)

Assist the authorization team member to meet their responsibility to quickly and accurately gain approval to identify patients benefit eligibility in relation to Applied Behavioral Analysis (ABA) services according to given patients insurance, as well as obtaining the requested number of units of services requested by the provider to be authorized by the insurance carrier and maintain data properly.

• Stay on top of benefits requests coming in through various methods such as email and client-specific application.
• Benefits checks should be completed within an hour.
• Know method used to verify benefits such as insurance portals, carrier portals, general portals, or calling into carriers.
• Check the process of documentation on requested insurance patients.
• Follow through detailed items that need to be checked, update information in the various systems according to specific client.
• Check monthly on eligibility to ensure that the given patient is still active with the given plan and know results in various systems based on specific clients.
• Complete specific process if a plan has been changed and/or terminated.
• Complete each authorization request coming in from all methods, email or client-specific applications, to be submitted to carriers for review.
• Complete and submit according to carrier guidelines.
• Follow up on each submitted request submitted.
• Discuss with authorization team member how to handle any delayed partial and full denials of authorizations and act accordingly.
• Follow the process of requesting single case agreements according to when the client is not yet participating with a given carrier network according to given rules in effect at given time for given practice group.
• Submit partial or full denied cases to autism advocacy groups and follow up with team member.
• Update various systems based on client's systems with accurate information authorization team received from carriers.
• Search near expiring authorizations which practice groups have not submitted for re-authorization.
• Communicate with authorization team member if a new carrier/plan which do not have rules or coding documented.
• Prepare email for the authorization team member with details for client regarding each item listed above.
• Attend daily meetings with authorization team member.
• Attend weekly team meetings, completing the to-do's assigned to authorizations team member.
• Other Duties as Assigned

• 2-year college degree
• 2-year experience in US-based medical billing practice or 2-year experience in a medical practice dealing with billing including but not limited to, provider credentialing, auth, reimbursement, etc. preferably in Behavioral Health to some degree
• Must have backup power supply (extra laptop/power bank/generator/UPS)
• Detail orientated with above-average organizational skill
• Able to plan and prioritize to meet deadlines
• Excellent verbal and written communication
• Communicates clearly and effectively
• Excellent reading comprehension
• Excellent computer skills, including Microsoft programs such as Excel, Word
• Thorough understanding of navigating the internet

Independent Contractor Perks

• Permanent work from home
• Immediate hiring

Please note that since this is a permanent work-from-home position and an "Independent Contractor" arrangement, the candidates must have their own computer and internet connection. They will handle their own benefits and taxes. The professional fees are on hourly rates and the rate depends on your performance in the application process.