You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a knowledgeable and experienced Prior Authorization Representative. The primary responsibility is to review physician orders and medical documentation for accuracy and completeness and manage prior authorization requests for a range of cardiology services. The goal is to hit 50 claims per day, with regular evaluations of this metric.
Key Responsibilities
- Review physician orders and medical documentation for accuracy and completeness.
- Submit prior authorization requests for cardiology services such as echocardiograms, stress tests, cardiac catheterizations, nuclear imaging, and specialty medications.
- Communicate with insurance carriers to obtain approvals or resolve denials.
- Track and follow up on outstanding authorizations to prevent delays in care.
- Document all authorization activities and maintain compliance with payer requirements.
- Work with commercial and government insurances.
Qualifications
- 3+ years of prior authorization experience.
- Experience working with commercial insurances.
- Computer savvy.
- ECW experience is preferred.
- Local to NYC area is preferred for in-person training, but remote work is available.
Skills
- Proficient in handling prior authorization processes.
- Experience with commercial insurances.
- Computer savvy.
- ECW experience is preferred.
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.
Required Employment / Compliance Language
Employment compliance is required in accordance with U.S. law and regulations.
*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.
