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Healthcare Prior Authorizations Specialist

2 weeks ago

Coos Bay, Oregon, United States Quadris Team LLC Full time

Quadris Team, LLC - A Revenue Cycle Management Group, is searching for that dynamic person to join us, working with our highly skilled Authorizations Team to fill the role of Prior Authorization Specialist. We are a 100% remote team supporting our clients across the United States See us at .

The ideal applicant will reside in Pacific Standard Time or Mountain Standard Time

Job Focus:

Responsible for obtaining prior authorizations for facility services based on assigned specialty or clinic area. This position will secure the prior authorization and notify the rendering party in the timeliest manner possible so patients can receive necessary care and services with the least delay.

Responsible for answering patient calls, providing outgoing patient communication regarding financial obligations and authorization status. Responsible for patient estimation, benefit education, and payment processing.

Primary/Essential Expectations For Success:

  • Accurately, efficiently and timely work prior authorization requests-referrals
  • Receive request for prior authorizations through the electronic health record (EHR) and/or via phone, email or fax and ensure that they are properly and closely tracked and monitored
  • Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
  • Manage correspondence with insurance companies, physicians, specialists and patients as needed, including documenting in the EHR as appropriate
  • Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
  • Review accuracy and completeness of information requested and ensure that all supporting documents are present
  • Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial
  • Prioritize the incoming authorizations by level of urgency and date of service
  • Secure patient information in accordance with client policy/procedures
  • Other duties as assigned
  • Monitors WQs, and resolves accounts in a timely manner
  • Stay up to date on insurance company policies and procedures related to prior authorizations

Physical/Mental Demands, Environment:

  • Prolonged periods of sitting at a desk and working on a computer
  • Must be able to lift 15 pounds at one time
  • Must be able to structure your home office to ensure patient information is secure meeting the regulatory expectations

Skills Needed to Be Successful:

  • Maintains compliance with regulations and laws applicable to job
  • Professional level of communication with video, phone, and email
  • Ability to effectively prioritize the work to meet deadlines and expectations
  • Meets the quality and productivity measures as outlined by Quadris
  • Brings positive energy to work
  • Uses critical thinking skills
  • Being present and focused on assigned tasks and eliminates distractions
  • Being a self-starter
  • Ability to work independently and within a team atmosphere

Core Talent Essentials:

  • High School diploma or equivalent
  • 1+ years of experience working in health care, medical billing, with a focus on prior authorization preferred
  • PACS (Prior Authorization Certified Specialist) Certification preferred
  • Knowledge of insurance process and medical terminology preferred
  • Honors and sets high expectations for patient confidentiality and customer service in accordance with Quadris Team policies and procedures and HIPAA requirements
  • Advanced level of industry standard electronic medical record content
  • Must have professional level skills in MS products such as Excel, Word, Power Point.
  • Proficient application of business/office standard processes and technical applications

Quadris is an Equal Employment Opportunity employer. Any offer of employment is contingent upon a criminal background check, previous employment verification and references, following all federal and state regulations. Quadris Team is a participant of eVerify.