Reimbursement, Pre-Billing Prior Authorization Specialist

POSITION OVERVIEW

This individual is responsible for all aspects of the prior authorization process, including collecting necessary documents, contacting providers and patients for additional information or assistance, and completing the required prior authorization. This position will also work closely with the Benefits Verification Team to validate patients' insurance plans.

ROLES & RESPONSIBILITIES

Ensure all pertinent medical documentation is accurate and present prior to authorization submission.

Maintain a high level of understanding of insurance companies and billing authorization/referral requirements.

Submit and follow up on assigned prior authorization requests.

Obtain authorization via the payer website or by phone and follow up regularly on pending cases.

Contact the referring physician's office for additional information as needed.

Manage any discrepancies, errors, or omissions in authorization denials.

Initiate verbal and written reconsiderations, appeals, or peer-to-peer reviews for denied authorizations.

Exhibit and manage excellent turnaround times to ensure timely authorizations.

Assign insurance plans and perform eligibility verification checks on new patient accounts entering the billing system.

Ability to multitask and remain focused while managing a high-volume, time-sensitive workload.

Identify and report payor trends or issues to the Billing Supervisor and Billing Manager.

Communicate and work effectively with teammates to set daily priorities and ensure turnaround time standards are met.

Collaborate with other departments to assist in obtaining prior authorizations in a cross-functional manner.

Must be able to work in an office at our client's office in Friendswood, TX location.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.

EDUCATION/EXPERIENCE

Minimum Requirements

High school diploma or equivalent work experience required.

Experience researching and utilizing payor websites or equivalent job experience with attention to detail.

Experience collaborating with multiple teams to achieve goals

Knowledge of prior authorization and its direct impact on the practice's revenue cycle

Proficient in Microsoft Excel, Word, and Outlook

Compiled and provided documentation and/or verbal clinical review where needed to substantiate medical necessity and obtain authorization for requested procedures.

Minimum, 1 year of experience in this role for the same company.

Typing speed of 30 or more words per minute, with 90% or greater accuracy.

Responds timely to requests, emails, voicemails, etc.

Excellent communication skills and the ability to articulate clearly verbally and in writing.

The ability to handle multiple simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner.

Exercises professional judgment and demonstrates good problem-resolution skills.

Team player with a positive attitude who is able and willing to help others.

Actively displays behaviors that support the mission, vision, and values.

Preferred Requirements

Minimum 2-year degree preferred and/or some college preferred.

Minimum of two years of experience in a related area preferred

Preferred experience collaborating with patients, providers, and insurance plans to complete the pre-billing process or equivalent job experience.

Preferred minimum of two years of health insurance eligibility and prior authorization experience or equivalent job experience.

Preferred experience collaborating with patients, providers, and insurance plans to complete the pre-billing process or equivalent job experience.

Experience researching and utilizing payor websites or equivalent job experience with attention to detail.

TRAVEL REQUIREMENTS & ENVIRONMENTAL CONDITIONS

<5% as needed for training and meetings.

Potential exposure to caustic, corrosive chemicals or bio-hazardous samples exists when in a laboratory area.

SCHEDULE

Monday - Friday, 8 hours per day.