You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Company Information

Our client is seeking a skilled Prior Authorization Specialist to join their team.

Job Summary

As a Prior Authorization Specialist, you will manage a high volume of prior authorization cases, ensuring timely approvals and minimizing appointment cancellations. Primary goals include maintaining productivity metrics related to volume and quality, and effectively contributing to denial reduction efforts.

Key Responsibilities

• Manage a high volume of prior authorization cases, with productivity metrics tied to volume and quality.
• Minimize appointment cancellations by ensuring timely authorization approvals and contributing to team-based denial reduction efforts.
• Maintain strong call metrics, including 80% "ready" status adherence during scheduled shifts and zero abandoned or avoided calls.
• Answer incoming customer calls regarding authorization, eligibility, and estimates.
• Utilize worklists to contact Utilization Management Companies or Insurance Payers for authorization requests.
• Perform and research eligibility searches, implementing necessary insurance updates in the RIS.
• Document all authorization and eligibility details accurately in suitable application fields.
• Follow referring physician-requested protocols for authorization processes and request support as needed.
• Communicate denials for medical necessity or cases requiring peer-to-peer review to referring physicians for resolution.
• Validate all authorizations for accuracy prior to patient exams.
• Contact patients directly to update insurance information, verify active eligibility, or discuss appointment options if authorization is not secured the day prior to service.
• Successfully complete a 30-90 day ramp-up period to meet productivity and quality targets.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.