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

Job Summary

As a Prior Authorization Specialist at our client company, you will play a critical role in the healthcare revenue cycle by acting as the bridge between providers, patients, and insurance payers. This remote position involves ensuring patients receive necessary medical approvals before services are rendered.

Key Responsibilities

• Request Management: Initiate, track, and obtain prior authorization requests for medical procedures, medications, and diagnostic tests.
• Clinical Coordination: Review medical records and clinical documentation to ensure all necessary information is submitted to the insurance company.
• Payer Liaison: Communicate directly with insurance companies via phone and web portals to follow up on pending authorizations and resolve denials.
• Documentation: Maintain meticulous records in the Electronic Health Record (EHR) system, including approval codes, effective dates, and specific coverage limitations.
• Problem Solving: Identify potential issues that could lead to denials and proactively work with clinical staff to gather additional supporting documentation.
• Patient Advocacy: Occasionally communicate with patients regarding their authorization status and explain the requirements of their specific insurance plans.
• Patient Scheduling: Coordinate and finalize patient appointments once authorizations are secured, ensuring that the timing of the service aligns with the approval window provided by the insurance payer.

Qualifications

• High School Diploma or GED.
• 1 – 2 years of authorization experience.
• Experience meeting metrics/KPIs in a fast-paced environment while maintaining satisfactory quality scores.

Experience

• Minimum 1-2 years of authorization experience in a relevant field.

Skills

• Proficiency with Meditech Expanse.
• Strong communication and problem-solving skills.
• High attention to detail and understanding of medical terminology and insurance protocols.

Additional Requirements

• Shift times are dependent on business need, but candidates should expect to work an 8-hour shift within normal business hours (7:30 AM - 5:30 PM EST).

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).

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.

^*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. 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.