Case Management, Clinical Information, Clinical Nursing, Clinical Study Publications, Communication Skills, Computer Skills, Cost Control, Cross-Functional, Customer Support/Service, Detail Oriented, Electronic Medical Records, Epic Systems, Federal Government, Federal Laws and Regulations, HIPAA (Health Insurance Portability and Accountability Act), Health Insurance, Healthcare Administration, Healthcare Common Procedure Coding System (HCPCS), Hospital, ICD-10, Industry/Trade Analysis, Insurance, Life Insurance, Medical Diagnosis, Medical Office, Medical Records, Medical Terminology, Medical Treatment, Medications, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft Word, Multitasking, Patient Care Authorizations, People Management, Philosophy, Presentation/Verbal Skills, Problem Solving Skills, Project/Program Management, Regulatory Compliance, Reimbursement, Revenue Management, State Laws and Regulations, Team Player, Training/Teaching, United States Citizen, Writing Skills
This is a remote based position. Applicants can be located nationwide
Prior Authorization Specialist
#2731
United States
Position Description
About You
You are a person who is passionate about working closely with Patient, Patient Access, Payers, and Providers' office to validate insurance plans, eligibility, and orders to procure required prior authorizations.
- Tell us about your experience with Prior Authorization.
- Are you a team player and a self-motivator?
- We are counting on you to manage multiple projects using your problem-solving skills.
- We are looking for someone UNCOMMON. What is uncommon about you?
Are you highly committed? Are you team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we cannot wait to meet you.
About The Position
- Collaborate with insurers to obtain pre-authorizations for condition-specific medications, diagnostic procedures and treatments, and support patients in navigating barriers / coverage and disputes.
- Submit prior authorization requests for medical procedures, diagnostic tests, treatments, and medications as required by insurance providers.
- Gather, review, and submit all necessary clinical documentation to support authorization requests, ensuring accuracy and completeness.
- Communicate with insurance representatives to clarify requirements, resolve authorization denials, and follow up on pending approvals.
- Collaborate with physicians, nurses, and other clinical staff to obtain additional clinical information or documentation required by insurance companies.
- Inform patients about the status of their authorization requests, answer questions regarding coverage, and provide guidance on next steps.
- Maintain accurate and detailed records of all prior authorization requests, outcomes, and patient information in compliance with HIPAA regulations.
- Stay updated on changes in insurance policies, state and federal regulations, and organizational policies affecting prior authorizations and reimbursement.
- Meet quality and productivity standards set by Signature and/or our client.
- Provide excellent customer service in keeping with Signature's legacy both internal and externally.
- Maintain expertise in multiple current client systems.
- Maintain up to date knowledge of revenue cycle management, industry trends perform other duties as necessary.
- Acts as an effective team member.
Minimum Requirements:
- Minimum of 2 years' experience in EPIC EMR/HER.
- Minimum 2 years of prior authorization experience, insurance coordination, or case management within a physician office, hospital, or insurance plan authorizations unit.
- Understanding of healthcare insurance systems
- Strong written and verbal communication skills with the ability to explain complex medical and insurance information
- Strong attention to detail
- Passion for patient advocacy with a problem-solving mindset, focusing on overcoming challenges to accessing care.
- Ability to work effectively both independently and as part of a multidisciplinary team
- Computer proficiency including Microsoft Office, Word, Excel and Outlook
- Ability to function effectively in a fast-paced environment.
- Personal traits of a high-level commitment, motivation, energy, team orientation, professionalism, trust, personal honesty and integrity, and a demonstration of placing others in a place of high value.
Preferred Requirements:
- Preferred experience and understanding of medical terminology
- General knowledge of CPT/HCPCS and ICD-10
About Us
You are uncommon. We are, too. We are looking for people to help us in our mission of working hard at lowering healthcare administrative costs for federal government agencies, payers, and providers. At Signature, our mission is to improve the health of our clients' business and make the lives of the people we work with better. As we continue to experience exponential growth, we are looking for uncommon individuals to enhance our vision. We will continue to accomplish our mission by leading with our values of Passion, Courage, Integrity, and Respect in all interactions, making us a consistent annual Best Places to Work organization. We need uncommon leaders with uncommon qualities to shape our uncommon culture and achieve our uncommon mission.
About the Benefits
When you are a member of Signature Performance, you are a part of a solutions-based organization where the values of passion, integrity, courage, and respect are the driving forces behind all our decision-making. We trust you to do important work and bring the best version of yourself to work every day, so we want to help you achieve a work-life balance while consistently challenging yourself. Signature believes in fully developing each one of our Associates. Our performance-driven philosophy boasts competitive pay and additional position specific incentives, where world-class training and development, resources, and events drive our award-winning culture where everyone thrives.
- Health Insurance
- Fully Paid Life Insurance
- Fully Paid Short- & Long-Term Disability
- Paid Vacation
- Paid Sick Leave
- Paid Holidays
- Professional Development and Tuition Assistance Program
- 401(k) Program with Employer Match
Security Requirements
- U.S. Citizenship, naturalized citizenship, or permanent status is required for this position.
- All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.
- U.S. Citizenship, naturalized citizenship, or permanent status is required for this position.
- All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.
This Company is an Equal Opportunity Employer, and does not discriminate on the basis of race, gender, ethnicity, religion, national origin, age, disability, veteran status, or on any other basis prohibited by law. Information on race, gender and national origin will only be used for statistical and recordkeeping purposes, and will not be used in making any employment decisions. All information provided will be kept separate from your expression of interest. Providing this information is strictly voluntary, and you will not be subjected to any adverse action or treatment if you choose not to provide this information. If you do not choose to answer these questions, we ask that you select "Decline to Identify" for each question. Thank you for your voluntary cooperation.