AI-Powered Prior Authorization Specialist

Ascertain; United States; Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Cutting-edge tech

Ownership & growth

Collaborative team

Competitive compensation

Job summary

Ascertain is building AI-powered prior authorization workflows to streamline complex healthcare operations. This hands-on role focuses on processing high-volume prior authorizations while serving as a resource for Ascertain Assistants, with potential evolution into a hybrid operations + technology position as automation expands.

You’ll work closely with healthcare providers to reduce administrative burdens, overseeing manual processing and automated submissions for office visits, procedures, and

Qualifications

• 4+ years of experience with prior authorization and billing in Cardiology.
• Experience with athenahealth or NextGen.
• Familiarity with major payors including UnitedHealthcare, Aetna, Blue Cross Blue Shield, etc.

Responsibilities

• Review and verify insurance information and patient eligibility for prior authorizations.
• Communicate with healthcare providers to gather necessary medical documentation and information.
• Submit prior authorization requests to insurance companies following established protocols.
• Monitor and track authorization requests to ensure timely processing and resolution.
• Respond to inquiries from healthcare providers, patients, and insurance companies regarding authorization status.
• Maintain accurate records of authorization requests, approvals, and denials.
• Collaborate with internal teams to resolve authorization issues and improve process efficiency.
• Stay updated on insurance policies, regulations, and industry trends related to prior authorizations.

Skills

Prior authorization

Billing in Cardiology

Payor knowledge

Tools

athenahealth

NextGen

Job description

Ascertain is building AI-powered prior authorization workflows to streamline complex healthcare operations. This hands-on role focuses on processing high-volume prior authorizations while serving as a resource for Ascertain Assistants, with potential evolution into a hybrid operations + technology position as automation expands.

You’ll work closely with healthcare providers to reduce administrative burdens, overseeing manual processing and automated submissions for office visits, procedures, and