We Help Companies Scale!
Prior Authorization Specialist
Location
Philippines
Posted
1 day ago
Salary
$4 - $5 / hour
Seniority
Senior
Job Description
Prior Authorization Specialist
1840 & Company
• Monitor the Prior Authorization queue and manage an organized list of outstanding and in-progress PAs. • Review patient and service data provided by the biller/clinical team for completeness and accuracy. • Submit new prior authorizations to the correct insurance company and plan efficiently via the required method, including insurance portals, fax, or telephone. • Proactively and consistently call insurance companies to check on the status of submitted prior authorizations to prevent processing delays. • Document all communication and status updates clearly and promptly in the patient management system. • Identify, prepare, and submit prior authorization denial appeals in a timely manner, gathering all necessary clinical and administrative documentation. • Track the status of all submitted appeals through resolution. • Monitor the designated fax inbox or electronic queue for prior authorization approvals, denials, and requests for additional information. • Promptly update the patient management system with the final PA status, authorization number, and expiration date upon receipt of approval.
Job Requirements
- Exceptional Attention to Detail: Crucial for accurately submitting data and preparing appeals.
- Strong Communication Skills: Excellent verbal and written communication skills for professional interaction with insurance representatives and clinical staff.
- English Speaking: Fluency in English is required to effectively communicate with insurance representatives and team members.
- Organizational and Time Management Skills: Ability to prioritize a high volume of PA requests and follow-up tasks under deadlines.
- Problem-Solving: Resourcefulness in troubleshooting issues with insurance company portals or processes.
- Team Player: Ability to work collaboratively with billing and clinical teams to achieve patient care goals.
- Medical billing experience (optional)
- Familiarity with various commercial and government payer systems (e.g., Medicare, Medicaid, and major commercial insurers)(optional)
- Proven knowledge of medical terminology, CPT codes, and ICD-10 codes (optional)
Related Guides
Related Categories
Related Job Pages
More General Jobs
Regional CoE Lead, Project Centric ERP
Project Partners, LLCThe world’s foremost experts in providing business solutions and IT systems for project-driven organizations.
• Own and develop BROADPIN's delivery capability in your solution area • Function as regional subject matter expert (SME) and primary escalation point for complex solution-related challenges • Support solution packaging, delivery readiness, and Innovation in collaboration with the COO and sales enablement functions • Provide pre-sales support on strategic opportunities, including proposal development, estimation, and solution design • Track and support revenue contribution of your CoE • Drive delivery quality and customer satisfaction across engagements involving your solution area • Manage and grow the team of consultants, architects, and specialists within your CoE • Align regularly with Global CoE Lead to drive cross-domain integration and knowledge sharing
• Tu identifies des entreprises qui pourraient bénéficier de nos services et tu établis le premier contact. • Tu qualifies les besoins et présentes notre offre de services. • Dès que le client est confirmé, tu collabores avec les RH pour assurer le succès du démarrage du mandat. • Tu effectues des suivis ponctuels avec le client afin de t'assurer de sa satisfaction et du bon déroulement du mandat. • Tu contribues au développement de relations d'affaires durables avec les clients.
• Teach advanced Physics lessons (regular, honors and AP) for High School (grades 9,10, 11 and 12) to an audience of 1-2 students in an online classroom setting. • Assign and Review daily lessons and homework • Administer quizzes and tests • Help students with homework, upcoming tests and clearing concepts • Provide feedback of students progress to parents • Promote positive, friendly, and fun learning atmosphere
• Provide 1st and 2nd level application support for our molecular and gene testing product portfolio (PCR, Sanger sequencing, NGS…) and for device installation • Support our affiliates and distributors in all application-related tasks, including installation, demonstration, on-site validation, training and troubleshooting • Ensure that product updates, complaint handling and post marketing surveillance are dealt with efficiently and effectively • Develop and conduct product and application training • Contribute to customer relationship management, understanding customer needs, setting appropriate product and performance expectations, and gathering market intelligence regarding competitive information and new sales opportunities • Feedback information to Product Marketing, Scientific, Technical, R&D, QM and other teams across the organisation as appropriate to help in the accurate marketing/further development of our products • Take responsibility for the application-related collaborations • Support organisation and take part in user group meetings, workshops, and exhibitions
