Prior Authorization Specialist

Jobtailor; Deutschland; Remote; EUR 38.000 - 54.000; Vollzeit

Zusammenfassung

Jobtailor in Germany seeks an experienced healthcare authorization specialist to manage insurance verification and prior authorizations using Epic and payer portals. You will coordinate financial clearance, pre-registration, and demographic verification while collaborating with patients, providers, and insurance carriers.

The role emphasizes accuracy, high-volume processing, and adherence to confidentiality with experience in Epic/Meditech systems preferred.

Qualifikationen

• High school diploma or GED required; associate degree preferred.
• 4-5 years of office experience in a high-volume data entry or healthcare setting.
• Experience with insurance verification, prior authorization, and financial clearance processes.
• Strong familiarity with Epic and Meditech systems is preferred.

Aufgaben

• Screen and prioritize prior-authorization requests and coordinate specialized services.
• Verify patient insurance and obtain authorizations through Epic and payer portals.
• Process authorization requests for inpatient, outpatient, and ancillary services.
• Coordinate financial clearance, pre-registration, and demographics verification.
• Obtain referrals and precertification numbers; document in CCMS/Facets.
• Answer calls and emails from providers, patients, and departments.
• Inform callers about network providers, services, and authorization decisions.
• Maintain confidentiality and follow regulatory policies and procedures.
• Collaborate with patients, providers, insurance carriers, and case management.
• Escalate denied or uncleared accounts; participate in process improvements.

Kenntnisse

Insurance Verification

Prior Authorization

Financial Clearance

Epic Proficiency

Customer Service Experience

Ausbildung

High School Diploma or GED

Associate’s Degree or Higher Preferred

Tools

Epic

Meditech

CCMS

Facets

ADT/Prelude/Grand Centrale

Microsoft Excel

Microsoft Word

Microsoft Outlook

Microsoft Zoom

Jobbeschreibung

Responsibilities

• Screen and prioritize prior-authorization and coordination-of-specialized-services requests
• Verify patient insurance and obtain authorizations through Epic and payer portals
• Process authorization requests for inpatient, outpatient, and ancillary services
• Authorize specified services under manager supervision and refer clinically complex requests for review
• Coordinate financial clearance, pre-registration, demographic and insurance verification activities
• Obtain referral authorizations and precertification numbers
• Answer ACD calls and emails from providers, patients, and departments
• Verify member eligibility and enter required information into CCMS or Facets
• Inform callers and providers about network providers, services, benefits, and authorization decisions
• Monitor and clear registration and prior-authorization work queues
• Obtain, document, and link referrals and prior authorizations to scheduled services in Epic
• Collaborate with patients, providers, physicians, practices, insurance carriers, case management, and Patient Financial Counseling
• Coordinate peer-to-peer reviews and **escalate** denied or financially uncleared accounts
• Interview patients, families, or referring physicians to obtain demographic, financial, and insurance information
• Reconcile registration and insurance information with payer records
• Refer self-pay or unresolved-insurance patients to Patient Financial Counseling
• Maintain confidentiality and comply with healthcare collection laws, regulatory policies, and organizational procedures
• Meet productivity, quality, accuracy, and turnaround-time expectations
• Participate in training, quality audits, onboarding, and process-improvement initiatives
• Report faulty systems or equipment to the appropriate support teams
• Perform other related duties as assigned

Requirements

• High school diploma or GED required
• Associate’s Degree or higher preferred
• 4-5 years of office experience in a high-volume data entry office, customer service call center, healthcare office, or hospital administration required
• Meditech experience strongly preferred
• Experience using insurance payer websites, such as Blue Cross Blue Shield and Medicare
• Customer service experience preferred
• Experience with insurance verification, prior authorization, pre-certification, and financial clearance processes
• Bilingual preferred
• Ability to process high-volume requests with a 95% or greater accuracy rate
• Ability to prioritize workload and process referrals and authorization requests within specified turnaround timeframes
• Strong oral and written communication skills
• Thorough knowledge of the financial clearance process
• Familiarity with insurance, referral authorizations, and third-party billing procedures
• Knowledge of basic medical terminology and ICD-9/CPT coding helpful
• Experience within Epic preferred
• Technical proficiency with Epic work queues and ancillary systems, including ADT/Prelude/Grand Centrale
• Microsoft Suite proficiency, specifically Excel, Word, Outlook, and Zoom
• Knowledge of medical terminology and/or coding
• Ability to maintain strict confidentiality of personal, health-sensitive, financial, and medical information
• Ability to make independent decisions under pressure
• Ability to multitask, manage complex processes, and maintain attention to detail

Core Competencies

Demonstrates expertise in insurance verification, prior authorization, and financial clearance processes, with proficiency in Epic and Meditech systems. Strong communication skills and the ability to manage high-volume requests while maintaining accuracy and confidentiality are essential.

Highest-signal resume keywords

• Insurance Verification
• Prior Authorization
• Financial Clearance
• Epic Proficiency
• Customer Service Experience

Hard Skills

• Data Entry
• Insurance Payer Websites
• ICD-9 Coding
• CPT Coding
• Referral Authorizations
• Third-Party Billing Procedures
• Medical Terminology
• High-Volume Request Processing
• Accuracy Rate of 95% or Greater
• Demographic Verification

Soft Skills

• Strong Oral Communication
• Strong Written Communication
• Attention to Detail
• Ability to Multitask
• Independent Decision-Making

Certifications & Qualifications

• High School Diploma or GED
• Associate’s Degree or Higher Preferred

Industry Keywords

• Healthcare
• Patient Financial Counseling
• Regulatory Policies
• Confidentiality
• Quality Audits

Tools & Technologies

• Epic
• Meditech
• Microsoft Excel
• Microsoft Word
• Microsoft Outlook
• Microsoft Zoom
• CCMS
• Facets
• ADT/Prelude/Grand Centrale