Prior Authorization Specialist - Hybrid/Remote

Paycom - ATS; Emmett (ID); Hybrid; USD 42,000 - 66,000; Full time

Benefits offered by this job

Flexible schedule

Hybrid work option

Job summary

Valor Health is seeking a Prior Authorization Specialist to obtain pre-certifications and pre-authorizations for procedures. The role focuses on developing and implementing prior authorization workflows and ensuring timely approvals.

You will contact insurance carriers, follow up on authorizations, and collaborate with billing and other departments to expedite care while maintaining accuracy and compliance.

Qualifications

• Minimum 3 years’ experience in healthcare.
• Minimum of 2 years’ experience as a Medical Assistant/CAN/LPN.
• Preferred experience with obtaining prior authorizations.
• Ability to communicate effectively with a wide variety of contacts at all levels of the organization.
• Strong organizational skills and attention to detail.
• Working knowledge of Microsoft Office applications.

Responsibilities

• Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements.
• Request, follow up and secure prior authorizations prior to services being performed.
• Prioritize incoming authorization requests according to urgency.
• Collaborate with other departments to assist in obtaining prior authorizations in a cross-functional manner.
• When necessary, work with billing specialist to obtain a retro authorization.
• Assist with medical necessity documentation and submit medical records 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.
• Attends and participates in meetings as requested.
• Performs other duties as assigned.

Skills

Communication

Organization

Detail orientation

Time management

Education

High school diploma or equivalent

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Valor Health is seeking a Prior Authorization Specialist to obtain pre-certifications and pre-authorizations for procedures. The role focuses on developing and implementing prior authorization workflows and ensuring timely approvals.

You will contact insurance carriers, follow up on authorizations, and collaborate with billing and other departments to expedite care while maintaining accuracy and compliance.