Prior Authorization Specialist

We are looking for a strong writer with clinical experience.  The Authorization Escalation specialist are responsible for the successful completion of prior authorizations for Medical Equipment.  This process requires high levels of organization, dedication, and persistence. The position serves as an advocate for patients to obtain approvals for their Durable Medical Equipment through the Department of Labor, working at an elevated level. This person must have the ability to problem-solve independently, able to address and resolve confrontation, and oversee daily functions of the authorization team, act as a authorization area float.  This position will work closely with medical benefit examiners at the DOL, case managers, patients, and all internal departments.   

Key Responsibilities

• Writing letters of medical necessity, avg 20 per day.
• Comfortable with talking on the phone.
• Comfortable working daily with insurance payers to gain prior authorization approval.
• Comfortable working with remote teams in multiple states.
• Understands and accurately applies requirements for prior authorization.
• Ensures eligibility and benefits are properly verified.
• Exhibits excellent customer service skills and serves as an advocate for the patient.
• Performs other related duties as assigned or requested in order to maintain a high level of service.
• Demonstrates professional work behavior by following Service Standards and Success factors.
• Complies with departmental organizational policies and procedures and adheres to external agency requirements.
• Ensure compliance with coding and billing regulations, including HIPAA and other industry guidelines.
• Maintain accurate and up-to-date documentation of job-related activities, including authorizations, claims, appeals, and communication internally and externally.

Required Knowledge and Skills

• Demonstrated work history of being successful with writing, handling prior authorizations, appeals and denials.
• Demonstrates clear communication and effective collaboration to optimize patient care and clinic operations.
• Strong writing skills.
• Excellent customer service skills.
• Ability to collaborate with others and offer outstanding customer service.
• Demonstrates a High degree of computer literacy in a PC environment.
• Strong organizational, interpersonal and communication skills.
• Previous experience of successfully completing federal payer authorizations preferred.
• Strong attention to detail and accuracy in data entry, documentation, and claims processing.
• Ability to handle confidential and sensitive information with discretion.
• Strong problem-solving and analytical skills to identify and resolve issues.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
• Knowledge of medical terminology, anatomy, and diagnosis codes, and or procedures.
• Ability to work independently in a remote setting while effectively managing team collaboration and project deadlines.
• Organized, proactive, and able to identify and address potential issues swiftly.

Education/Licensure/Technical Requirements.

• High school Diploma or equivalent required.
• Medical Assistant Degree, LPN, RN, or equivalent preferred.
• 2 years Medical Experience highly preferred.
• Brightree Experience preferred.
• DOL Experience.
• Six months of experience with prior authorizations, federal and commercial preferred.
• Ability to meet U.S. employment and eligibility requirements.