Eligibility and Prior Authorization Specialist - Remote

Overview

The Eligibility and Prior Authorization Specialist is responsible for building and maintaining collaborative relationships with internal and external stakeholders to support eligibility verification and prior authorization processes. This role involves managing revenue cycle projects, driving operational performance related to reimbursement, and overseeing processes impacting cash collections.

In Short

• Conduct thorough prior authorization case reviews and follow-ups.
• Accurately document all authorization activities in designated systems.
• Address denied or delayed authorizations by investigating issues.
• Exercise critical thinking to evaluate case statuses.
• Serve as a source of knowledge for the designated revenue cycle function.
• Perform analysis, identify trends, and prioritize initiatives.
• Establish ongoing working relationships with other departments.
• Work closely with vendor operations teams for optimal reimbursement.
• Track outcomes of payment resolutions and appeals.
• Monitor eligibility and prior authorization changes.

Requirements

• Proficiency in medical billing systems and Microsoft Excel.
• Strong knowledge of medical terminology and coding standards.
• Ability to work independently and collaboratively.
• Critical thinking skills to identify trends and implement solutions.
• Strong communication, organizational, and problem-solving skills.
• Analytical skills to assess data effectively.
• Maintain confidentiality of sensitive information.

Benefits

• Comprehensive medical, dental, vision, life, and disability plans.
• Free testing for employees and their immediate families.
• Generous employee referral program.
• 401k benefits and commuter benefits.
• Pregnancy and baby bonding leave.