Prior Authorization Specialist

Job Overview:
As a Prior Authorization Specialist, you will play a vital role in ensuring seamless access to our services for our clients. Your primary responsibility will be to navigate the prior authorization process with insurance companies and pharmacies, ensuring that our clients receive timely approval for necessary treatments and medications. You will serve as a liaison between our company, insurance providers, and pharmacies, advocating for our clients’ needs and facilitating efficient communication and documentation.

As a Prior Authorization Specialist, you play a pivotal role in serving our patients by ensuring timely approval of medical medications by collaborating with our healthcare providers, patients, insurance companies, and pharmacies. Your primary focus is to efficiently complete the prior authorization process, minimize treatment delays, and optimize reimbursements for our patients.

Responsibilities:
Prior Authorization Process Management:
– Complete and submit prior authorization forms accurately and promptly to insurance companies.
– Monitor the status of prior authorization requests and follow up with insurance companies as needed to expedite approvals.
– Maintain organized records of all prior authorization requests, approvals, and denials.
– Review denials and follow up with the provider to obtain the medically necessary information to submit an appeal of the denial if needed.

Insurance Verification and Assessment:
– Verify insurance coverage and assess clients’ insurance cards for relevant information, including eligibility, coverage limits, and authorization requirements.

Liaison with Insurance Companies and Pharmacies:
– Make outbound calls to insurance companies and pharmacies to gather information and resolve any issues related to prior authorizations.
– Communicate authorization status to internal team members and patients as needed.

Documentation and Reporting:
– Maintain accurate and up-to-date documentation of all interactions, authorizations, and communications related to prior authorizations.

Requirements:
– Bachelor’s Degree in Allied Health profession (Nursing, Physical Therapy, Occupational Therapy, Psychology, etc.)
– Prior experience working in prior authorization, insurance verification, or related roles, as well as a strong understanding of
insurance policies, prior authorization processes, and medical terminology.
– Excellent communication skills, both verbal and written, with the ability to effectively interact with patients, insurance
companies, and internal team members.
– Highly organized with exceptional attention to detail and the ability to manage multiple tasks simultaneously in a fast-paced
environment.
– Ability to work Eastern Time Zone
– Strong at-home internet access

TO APPLY:
Share your resume AND a brief 1-minute video where you introduce yourself and discuss your related work experience. Please share the video in a Google Drive link. Thank you!