Prior Authorization Specialist

Prior Authorization Specialist

Company Overview

We provide evidence based, results oriented therapy which is tailored to meet the needs of each individual. Our therapists use motivating and fun activities to encourage children, capture their interest, and provide successful and motivating experiences in order to help children to progress in their skills and to develop a love for learning and a strong self-esteem. In addition, Therapy Tree values communication, teamwork, mentorship and professional growth opportunities throughout your career.

The Opportunity

In need of a REMOTE Part Time/1099 and experienced PA Specialist to join our team! join a team of highly qualified and passionate individuals that seek to make a meaningful and lasting impact in the lives of children.

Requirements
– Handles requests for treatment authorization and referral authorization requests including out-of-area referrals, and verifies member plan eligibility.
– Conducts research on member auth requests and handles complex Provider inquiries.
– Translating for patients that do not speak English (If hired as a Bilingual Prior Auth Coord)
– Interviews and assists patients with authorization documents, as appropriate.
– Reviews Auth Requests for completeness prior to forwarding to designated person.
– Maintains appropriate logs or reports according to professional, state, and federal requirements.
– Monitors and tracks patient authorizations, informing the Manager of any expired dates.
– Ensures payment for services by verifying benefits with the insurance provider.
– Obtains, reviews and inputs insurance authorization and referrals prior to patient services.
– Verified member plan eligibility, with subsequent notification to designated staff of eligibility issues.
– Initiates extensive phone contact with providers, requesting additional information for review based on Prior Authorization requirement protocols where necessary.
– Adheres to the established criteria and timeframes for processing urgent authorization or referral requests.
– Provides effective departmental communication with both internal and external customers.
– Processes member and provider notices in accordance with established timeframes.
– Ensures that any changes made to the authorization request or referral forms have been submitted directly from the requesting provider via electronically or by fax.
-Documents all amendments received from providers on the Provider Change Request Form in the designated electronic systems within the established time frame.
-Identifies, maintains and protects sensitive HIPAA information (PHI) and follows procedures to ensure the security of such information.
-Collaborates with Manager, Providers and Medical Billing Staff to resolve problematic Authorization issues.

Benefits
Monthly Salary: P40,000 to P50,000
Work from home set up
Competitive salary
HMO after 6 months

Come grow with us and join an organization that’s committed to the future of our children and families!