Prior Authorization Specialist - Hybrid/Remote Path

RemX | The Workforce Experts; Salt Lake City (UT); Híbrido; USD 68.770.000 - 80.231.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Hybrid/Remote after training

Breakroom snacks

Business casual environment

Descripción de la vacante

RemX | The Workforce Experts in Sandy, Utah is actively hiring 7-10+ Prior Authorization Specialists to support a growing healthcare team. This role focuses on accurate prior authorizations, insurance verification, benefits investigations, and appeals, with opportunities to grow into a hybrid or remote schedule.

You’ll join a professional environment, enjoy a supportive team, and receive training with the potential to transition to hybrid or remote work after six months.

Formación

• Experience in Insurance Verification or Benefits Investigation.
• Experience with Appeals and Denials preferred.
• Background in healthcare, medical office, or insurance.
• Strong attention to detail and documentation.
• Ability to interpret insurance policies.
• Experience navigating multiple payer systems.
• Excellent communication and customer service skills.
• Salesforce experience is a plus.

Responsabilidades

• Process prior authorization requests accurately and efficiently.
• Review payer requirements, step therapy guidelines, and authorization criteria.
• Manage insurance denials and appeals following payer protocols.
• Verify insurance benefits and determine in-network vs out-of-network coverage.
• Evaluate medical and pharmacy benefits to determine patient eligibility.
• Analyze insurance policies and gather supporting documentation from providers.
• Communicate professionally with providers, patients, payers, and internal teams.
• Maintain timely and accurate documentation within Salesforce and other systems.
• Ensure compliance with payer regulations and internal quality standards.

Conocimientos

Prior Authorization

Insurance Verification

Benefits Investigation

Appeals

Healthcare Administration

Herramientas

Salesforce

Descripción del empleo

RemX | The Workforce Experts in Sandy, Utah is actively hiring 7-10+ Prior Authorization Specialists to support a growing healthcare team. This role focuses on accurate prior authorizations, insurance verification, benefits investigations, and appeals, with opportunities to grow into a hybrid or remote schedule.

You’ll join a professional environment, enjoy a supportive team, and receive training with the potential to transition to hybrid or remote work after six months.