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Entry-Level Prior Authorization Representative

2 months ago

Framingham, United States HealthDrive Full time

 

HealthDrive is seeking an enthusiastic entry-level, full-time Prior Authorization Representative to join our team The Prior Authorization Representative is responsible for the effective procurement and follow-up on documentation required for products and services to be rendered to patients.

 

We are conveniently located off Route 9 in Framingham, Massachusetts, close to routes 90 and 495 in a spacious modern office with a workout center available right in the building

 

What's in it for you: PPO Medical, Dental, and Vision Insurance, 401(k) + Company match, Paid Time Off, hybrid schedule opportunity, monthly meal program, Verizon Wireless, Dell, and other employee discounts, profit sharing, and employee referral bonuses.

 

HealthDrive delivers on-site dentistry, optometry, podiatry, audiology, behavioral health, and primary care services to residents in long-term care, skilled nursing, and assisted living facilities. Each specialty offered by HealthDrive is one that directly impacts the quality of daily life for the deserving residents we serve. HealthDrive connects patients in need of vital healthcare to doctors committed to dignity and excellence.

 

HealthDrive is a place where everyone can grow and training is provided. Join our diverse team today

 


 

  • Identify and request documents as needed for products and services
  • Effective follow-up on outstanding documentation. Tasks include:
    • Outreach to insurance payers
    • Outreach to primary care physicians
    • Coordination of outreach to patients or responsible parties
    • Coordination of outreach to Sales
    • Calling responsible parties, facilities for needed assistance
    • Calling, faxing to insurance companies for prior authorization approvals when needed
  • Manage documents in queue to ensure:
    • All outstanding items are followed-up on appropriately
    • Deadlines for service are met
    • Pipeline on DME items is efficient
    • Billing criteria are met
  • Update computer system as required for documentation tracking, service delivery, etc.
  • Send all necessary paper work to providers for ordering of hardware items
  • Scan original documents into the computer system and attach to appropriate patient record
  • Coordinate and complete documentation mailings as necessary
  • Order DME items from lab(s) as appropriate/required; includes requesting documentation
  • Update managers/supervisors with feedback from customers to improve services or provide recognition of staff members
  • Other duties and tasks may be assigned as appropriate or necessary

 


 

Skills & Specifications

This individual must have excellent interpersonal skills and a strong ability to communicate both verbally and in writing. The Prior Authorization Representative must be a creative problem-solver and have the ability to follow up consistently and diligently. Be highly organized and professional. Have an ability to pay close attention to detail. Be comfortable in speaking with providers, vendors, customers, and responsible parties as needed. Must be able to work in a fast-paced environment. Ability to navigate in all HealthDrive operating systems. This individual should be self-motivated and have the ability to work effectively with minimal supervision.

 

Physical Requirements

  • Ability to sit for long periods of time
  • Ability to use office equipment such as computer, phone, fax, and copier
  • Ability to lift up to 10 lbs occasionally for duties related to office work

 

Education & Qualifications

To qualify for this role the individual must have a minimum of an Associate’s Degree or equivalent work experience.

 

Work Environment

Office setting. Desk/Computer/General Office Equipment. The noise level in this work environment is usually light to moderate.

 

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