Prior Auth Executive with coding knowledge

Indus Medica Management Services; United States; Remote; USD 45,000 - 70,000; Full time

Job summary

A healthcare management company is looking for an experienced Prior Authorization Executive. The role involves verifying authorizations, collaborating with insurance providers, and managing documentation efficiently. Candidates should have a CPC or CCS certification and be prepared to work night shifts. Strong analytical and communication skills are essential for success in this position.

Benefits

Best in the industry benefits discussed after interview

Qualifications

• Minimum 1 year experience in prior authorization.
• Required to work the night shift.
• Excellent written and verbal English skills.

Responsibilities

• Responsible for verification and investigation of authorization requirements.
• Communicates with insurance companies and clinical partners.
• Ensures timely and accurate insurance authorizations are in place.

Skills

Analytical skills

Communication skills

Knowledge of medical terminology

Multitasking

Education

Life Science Graduate or similar

CPC or CCS

Tools

MS Excel

MS Word

Google Drive

Job description

We are looking to recruit an experienced Prior Authorization executive who also has a knowledge on CPT / HCPCS Codes as well and can work Independently.

Role & responsibilities

• Pain management experience is preferred
• Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services / procedures
• Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt
• Knowledge in Medical Terminology, knowledge of the different types of health insurance plans: i.e., HMO, PPO, POS etc.
• Obtains prior-authorizations and referrals from insurance companies prior to procedures or Surgeries utilizing online websites, via telephone or FAX
• Obtains and/or reviews patient insurance information and eligibility verification to obtain prior-authorizations for injections, DME, Procedures, and Ambulatory surgeries
• Provides insurance company with clinical information necessary to secure prior-authorization or referral. - Good understanding of the medical terminology and progress notes
• Review doctor consultation notes to properly answer clinical questions
• Coordinates and supplies information to the Insurance company including medical information and / or letter of medical necessity for determination of benefits
• Document the detail notes and attach the approved Auth/Referral to patient encounters
• Monitors and updates current Orders and Tasks to provide up-to-date and accurate information
• Collaborates with designated clinical contacts or Providers regarding encounters that require escalation to peer-to-peer review.
• Communicates with clinical partners and others as necessary to facilitate authorization process
• Request retro-authorizations when needed. - Communicates with practices when prior
• authorization is unable to be obtained and requires peer-to-peer and/or different study
• Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner.
• Completes accurate documentation in both the Auth / Cert and Referrals
• ENSURES TIMELY AND ACCURATE INSURANCE AUTHORIZATIONS ARE IN PLACE PRIOR TO SRRVICE BEING RENDERED
• Follows departmental policies and procedures (Alerting front desk to get ABN signed,), when the necessary authorization is not obtained prior to service date
• Answers provider, staff and patient questions surrounding insurance authorization requirements.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations
• Communicate any insurance changes or trends among team
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
• Denial management, finding trends / Medical policies beneficial for pre-auth process / Identify and report trends and prior authorization issues relating to billing and reimbursement
• Performs other related duties as required or assigned
• Generate self-productivity reports for supervisory review
• Minimum 1 year experience in initiating and following prior-authorization / Referrals etc.
• Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing Strategies to resolve problems

Preferred candidate profile

• CPC or CCS is MUST
• Healthcare RCM knowledge, preferred
• Analytical skills and good communication skills
• Ability to clearly articulate actions taken and articulate next steps
• Should be willing to work in Night shift
• Excellent written and verbal English
• Ability to multitask
• Good computer skills including MS Excel, MS Word, Google Drive
• Minimum 1 year experience in initiating and following prior-authorization (Pain management preferred)
• Knowledge of key medical and billing terms
• Consistent attendances during night shift
• Quick and eager to learn and mold accordingly to the process needs
• Ability to effectively handle multiple priorities within a changing environment
• Life Science Graduate OR any stream with relevant work experience

Perks and benefits

Best in the industry but will be discussed only after interview