PHRN Prior-Authorization Specialist | Work From Home - Remote

Overview

ISTA Solutions is seeking an experienced PHRN to join our team, focusing on Prior Authorization processes in a supportive and employee-centric environment.

In Short

• Receive and review claims requiring Prior Authorization.
• Utilize the CMM key for clinical questionnaires.
• Extract clinical information from PCC to support PA submissions.
• Complete and submit Prior Authorization requests accurately.
• Maintain documentation of actions taken.
• Ensure compliance with guidelines and standards.
• Meet productivity and turnaround time expectations.

Requirements

• Experience in Prior Authorization processes.
• Familiarity with clinical documentation and health plans.
• Ability to work independently and meet deadlines.
• Strong attention to detail and accuracy.
• Excellent communication skills.

Benefits

• Work from home flexibility.
• Supportive team environment.
• Focus on employee satisfaction and work-life balance.
• Opportunities for professional development.
• Culture of long-term success and learning.