Prior Authorization Specialist
2 weeks ago
Connext is a dedicated team of business process outsourcing experts and innovators, with experience in supporting world-class companies in Title and Escrow, Healthcare, Produce Distribution, Retail and Fashion, Design Consulting, and Finance.
We are currently looking for a Prior Authorization Specialist who will be working with Connext's Client in the United States of America.
What's in it for you?
- Competitive compensation
- Perfect Attendance Bonus
- Life insurance
- HMO Insurance
- Great company culture
- 25% Night Differential
- Annual Increase
- 13th Month Pay
- Mid-Year Bonus
What is the job?
The Prior Authorization Specialist is responsible for conducting insurance verifications and obtaining prior authorizations for a diverse range of therapy services, including Physical Therapy, Occupational Therapy, Speech Therapy, Autism Therapy, and Outpatient Behavioral Health.
Responsibilities
- Verify patient eligibility, benefits, referrals, and authorization requirements across payers, states, and specialties within SLAs.
- Collaborate with providers to collect accurate patient and medical records and relay authorization decisions.
- Complete prior authorizations efficiently via insurance portals or direct calls with insurers.
- Follow up with insurers to ensure timely approvals and provide additional documentation as needed.
- Manage multiple prior authorizations simultaneously while optimizing processes for high performance.
- Serve as a subject matter expert in prior authorization workflows, ensuring compliance with HIPAA and effective stakeholder communication.
Qualifications
- Minimum one year of medical billing/benefits experience with a stable employment history.
- Strong knowledge of insurance policies, medical billing processes, CPT coding, deductibles, co-insurance, out-of-pocket costs, and benefit exclusions.
- Proficient with EMR/EHR systems, Practice Management Systems, and insurance portals.
- Experienced with HMO, PPO, POS, EPO, Medicare, and Medicaid referral and authorization processes.
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