Healthcare Prior Authorizations Specialist - REMOTE

Quadris Team, LLC; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player in healthcare is seeking a Healthcare Prior Authorizations Specialist to join their dynamic remote team. This role focuses on securing prior authorizations efficiently, ensuring patients receive necessary care without delay. The ideal candidate will communicate effectively with patients and insurance companies while maintaining compliance with regulations. Join a supportive environment where your contributions directly impact patient care and service quality. If you have a passion for healthcare and are a self-starter, this is the perfect opportunity for you!

Qualifications

• 1+ years of experience in healthcare, focusing on prior authorization preferred.
• Knowledge of insurance processes and medical terminology preferred.

Responsibilities

• Obtain prior authorizations for facility services based on assigned specialty.
• Manage correspondence with insurance companies and patients as needed.

Skills

Prior Authorization

Communication Skills

Critical Thinking

Medical Terminology

Customer Service

Education

High School Diploma

PACS Certification

Tools

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Job description

Healthcare Prior Authorizations Specialist - REMOTE

Join to apply for the Healthcare Prior Authorizations Specialist - REMOTE role at Quadris Team, LLC

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Healthcare Prior Authorizations Specialist - REMOTE

Join to apply for the Healthcare Prior Authorizations Specialist - REMOTE role at Quadris Team, LLC

Quadris Team, LLC - A Revenue Cycle Management Group, is searching for that dynamic person to join us, working with our highly skilled Authorizations Team to fill the role of Prior Authorization Specialist. We are a 100% remote team supporting our clients across the United States! See us at www.quadristeam.com.

The ideal applicant will reside in Pacific Standard Time or Mountain Standard Time.

Job Focus

Responsible for obtaining prior authorizations for facility services based on assigned specialty or clinic area. This position will secure the prior authorization and notify the rendering party in the timeliest manner possible so patients can receive necessary care and services with the least delay.

Responsible for answering patient calls, providing outgoing patient communication regarding financial obligations and authorization status. Responsible for patient estimation, benefit education, and payment processing.

Primary/Essential Expectations For Success

• Accurately, efficiently and timely work prior authorization requests-referrals
• Receive request for prior authorizations through the electronic health record (EHR) and/or via phone, email or fax and ensure that they are properly and closely tracked and monitored
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
• Manage correspondence with insurance companies, physicians, specialists and patients as needed, including documenting in the EHR as appropriate
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
• Review accuracy and completeness of information requested and ensure that all supporting documents are present
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial
• Prioritize the incoming authorizations by level of urgency and date of service
• Secure patient information in accordance with client policy/procedures
• Other duties as assigned
• Monitors WQs, and resolves accounts in a timely manner
• Stay up to date on insurance company policies and procedures related to prior authorizations
  
  

Physical/Mental Demands, Environment

• Prolonged periods of sitting at a desk and working on a computer
• Must be able to lift 15 pounds at one time
• Must be able to structure your home office to ensure patient information is secure meeting the regulatory expectations
  
  

Skills Needed To Be Successful

• Maintains compliance with regulations and laws applicable to job
• Professional level of communication with video, phone, and email
• Ability to effectively prioritize the work to meet deadlines and expectations
• Meets the quality and productivity measures as outlined by Quadris
• Brings positive energy to work
• Uses critical thinking skills
• Being present and focused on assigned tasks and eliminates distractions
• Being a self-starter
• Ability to work independently and within a team atmosphere
  
  

Core Talent Essentials

• High School diploma or equivalent
• 1+ years of experience working in health care, medical billing, with a focus on prior authorization preferred
• PACS (Prior Authorization Certified Specialist) Certification preferred
• Knowledge of insurance process and medical terminology preferred
• Honors and sets high expectations for patient confidentiality and customer service in accordance with Quadris Team policies and procedures and HIPAA requirements
• Advanced level of industry standard electronic medical record content
• Must have professional level skills in MS products such as Excel, Word, Power Point.
• Proficient application of business/office standard processes and technical applications
  
  

Quadris is an Equal Employment Opportunity employer. Any offer of employment is contingent upon a criminal background check, previous employment verification and references, following all federal and state regulations. Quadris Team is a participant of eVerify.

Salary: $18.50 - $21.00 per hour

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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