Prior Authorization Specialist

4 weeks ago

Fort Lauderdale, United States PainPoint Health Full time
Job DescriptionJob DescriptionJob description

We are currently seeking a remote Prior Authorization Coordinator. This individual will be responsible for all aspects of the prior authorization process for interventional pain management procedures in an office or outpatient setting including advanced procedures.

Your responsibilities will include:

  • Monitor Advanced procedure trackers for each practice and identify opportunities to assist with the authorization process.
  • Collecting all the necessary documentation to obtain prior authorization.
  • Review medical necessity guidelines for all procedures by payor
  • Contacting the practice for additional information and completion of the required prior authorization in order to proceed with procedures and medication requests
  • Complete, timely, and accurate identification and submission of prior and retro authorization requests to the payors
  • Interacts with pain practices, vendors, insurance companies, patients, and management, as necessary, to request for prior authorizations
  • Responsible for documenting account activity, updating patient and claim information and demonstrating proficiencies with the prior authorization system to ensure all functionalities are utilized for the most efficient processing of claims
  • Identifies prior authorization trends and/or issues resulting in delayed claims processing.
  • Provides the highest level of customer service to internal staff
  • Serves as a backup to the Contact Center Team to receive inbound calls for patient scheduling as needed during peak hours of high call volume

Compensation Package

  • Performance-based bonus incentives
  • A wide range of benefits including paid time off (PTO), 401k, medical, dental, vision insurance, and more
  • Respect and value of diversity, integrity, and teamwork

General Duties

  • Prior Authorization:
  • Notify the provider offices on any delays with pending prior authorizations
  • Coordinate with the provider offices on any items needed to submit a timely prior authorization
  • Status pending prior authorizations (electronically or via phone call)
  • Submit prior authorizations in the approved system
  • Input prior authorization number into the EMR per policy
  • Coordinate STAT or urgent prior authorization with the provider office
  • Contact Center Team:
  • Respond to patients via telephone by assessing needs and answering general questions regarding treatment options
  • Register and schedule new patients; send appropriate patient materials prior to initial appointment
  • Make appropriate scheduling changes, canceling, rescheduling and confirming appointments
  • Provide excellent and timely customer service
  • Maintain operations by following policies and procedures
  • Taking inbound calls to schedule new and existing patients for an assigned practice

Requirements

  • High School diploma/GED required
  • Proficiency with basic computer functions including mouse and keyboard usage, launching applications, conducting searches on the Internet, and maneuvering in a Windows-based environment strongly preferred
  • Collaborative - You appreciate direct coaching/feedback to identify your strengths and opportunities for improvement
  • At least one (1) year of Prior Authorization experience is required
  • Basic understanding of medical terminology (1) year in a clinical setting
  • Familiar with navigating payor portals to obtain authorization and medical policies
  • Strong organizational skills

Job Type: Full-time

Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

An Equal Opportunity Employer

We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.

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