Prior Authorization Specialist – Behavioral Health (Permanent Work from Home)

MedCore Solutions, a single-source solution for Healthcare administration, is seeking a skilled and experienced US Healthcare Credentialing Specialist for a permanent work-from-home position. As the US healthcare industry grows, there is an increasing demand for qualified and reliable professionals to manage the credentialing process.

The Prior Authorization Specialist we be primarily responsible for obtaining all types of prior authorizations. These prior authorizations will include biologic medications, procedures, prescriptions and out-patient testing. The position will require professional and courteous interaction with patients, pharmaceutical representatives, providers, pharmacies and insurance carriers to accurately obtain the required information to process prior authorizations.

Responsibilities:
Review and process prior authorization requests for medical services, procedures, and medications
Verify insurance (pharmacy) information and eligibility
Handle patient inquiries regarding authorizations
Provide necessary prior authorization documentation to patients for completion and signature. Review all forms for completeness and accuracy.
Accurately document all patient, pharmacy and insurance carrier interactions in EMR.
Coordinate with healthcare providers and insurance companies to obtain necessary authorizations
Ensure accurate and timely documentation of authorization requests and approvals
Collaborate with medical billing team to resolve any issues or denials
Maintain up-to-date knowledge of insurance guidelines and procedures
Complete other tasks as assigned by providers through EMR/EHR
Copy, fax and mail documents and information as requested by insurance carrier
Schedule follow-up appointments, biologic injections and photodynamic therapy treatments
Assist pathology department with notifying patients of pathology results via telephone
Fulfill organizational responsibilities as assigned, which may include but are not limited to: respecting and promoting patient’s rights, responding appropriately to emergency situations, sharing problems relating to patients and/or staff with Care Center Leader in a timely manner
Provide safe patient-centered, compassionate, and competent care
Other details:

Requirements:
Proven 3-5 years of experience as a Prior Authorization Specialist in the US Healthcare
At least 1 year of experience in Behavioral Health – recovery, substance use (prior authorization)
Strong understanding of medical billing and insurance processes
Excellent communication and interpersonal skills
Detail-oriented with strong organizational skills
Ability to work independently and meet deadlines
Comfortable working in a remote, work-from-home setup
Experience using CareLogic is a bonus
Amenable to work in a graveyard shift

System Requirements:
Own Desktop/Laptop
Computer Processor: Intel I3/AMD Ryzen 3/MAC Intel I5
RAM: At least 4GB of RAM (8GB is recommended) with sufficient hard disk space available
Internet Connectivity: At least 20-25 Mbps and up wired Internet Connection
Back-up Connections & Power Supply: USB sticks, hotspots, signal-based & wireless connections only for back-up
Peripherals: Headset with noise-canceling feature

Permanent Work From home
Permanent Weekends Off
Great Company Culture and No Micromanagement
Continued Education
Specialized Training