Job Summary We prioritize our clients above all else, and our dedication extends to recruiting staff who excel in patient care, customer service, technology support, and operations. We are currently looking for an Independent Contractor to join us as a Prior Authorization Specialist. In this role, you will be a valued team member, contributing to the procurement of medical authorizations for patients across various insurance levels. Additionally, you will play a key role in resolving claim denials, supporting the appeals team when needed.

Essential Functions

Reviews procedure requests for authorization needed based upon insurance standards while drawing upon experience and general knowledge. Reviews documentation or contacts the provider when necessary to supplement the order to prove medical necessity.

Establish contact with the physician’s office or customer service department to resolve issues concerning missing vital information from patient’s record.

Contact insurance carriers to obtain necessary prior authorizations.

Submits all authorizations with correct CPT and diagnosis codes.

Review and take corrective action on denied prior authorizations.

Maintain up to date information on various insurance companies and any relevant changes.

Handle incoming and outgoing calls from internal team members, insurance payers and customers related to clinical documents and insurance benefits.

Provides quality customer service to our clients.

This position requires professionals to spend extensive amounts of time on the phone with insurance companies.

Work cordially within a team and participate in meetings, sharing ideas and information.

Ability to relate with people of diverse backgrounds, provide excellent customer service and solutions to problems.

Participate in various projects and/or meetings, and complete other tasks as assigned by the Team Leader and/or management.

Maintain strictest confidentiality; adheres to all HIPAA guidelines/regulations.

Qualifications

Required: High school diploma.

1-2 years in customer service oriented environment preferred.

1-2 years working within the insurance industry in a provider’s office, insurance company, or company where you were involved with employee benefits is preferred.

Ability to work independently, give attention to detail, prioritize and perform several tasks together without losing concentration.

Knowledge of insurance cards, medical insurance terminology, medical benefits, and CPT and ICD 9/10 coding.

Must be able to follow established procedures.

Excellent typing and computer usage skills, including Microsoft Word and Excel proficiency.

Must possess good oral and written (English) communication skills.

Must be well organized and detail-oriented.

Expectations and Commitment

As an Independent Contractor, you will be using your own computer that meets our IT requirements.

This is a remote position.