Prior Authorization Specialist - Remote After Training (Ohio)

Quadax, Inc.; Middleburg Heights (OH); Remote; USD 26,000 - 30,000; Full time

Job summary

Quadax, Inc. is seeking a detail-oriented insurance billing specialist for a remote position that requires 3 months of on-site training at our Middleburg Heights, Ohio facility. Applicants must reside in Ohio.

The role involves reviewing medical claims, managing prior authorizations, and communicating with insurance companies and physicians. Ideal candidates have prior health insurance billing experience, strong knowledge of medical terminology, and proficiency in Excel and Word.

Qualifications

• High School diploma or GED is required.
• Previous health insurance billing experience desirable.
• Working knowledge of medical terminology required.
• Excellent written and verbal communication skills needed.
• Proficiency with Microsoft Excel and Word is expected.

Responsibilities

• Review case and insurance coverage information to customize the prior authorization request to the insurance company or physician’s office.
• Navigate through payer portals to initiate/obtain prior authorization status.
• Provide insurance company representatives with an overview of the services being submitted for prior authorization.
• Answer questions regarding the reimbursement process and direct testing specific and treatment questions.
• Complete LOMN (letter of medical necessity) form based on client or insurance requirements and fax to the ordering physician’s office for completion.
• Follow up with the insurance company or physician’s office as needed.
• Meet benefit investigation process standards by completing assigned worklist tasks in a timely manner and/or reporting to management when assistance is needed to complete the task.
• Participate in team meetings by sharing the details of cases worked.
• Comply with all applicable SOPs.
• Meet or exceed productivity and quality KPI goals.
• Perform other duties as assigned.

Skills

Health insurance billing

Medical terminology

Attention to detail

Communication

Excel & Word

Multitasking

Education

High School diploma or GED

Tools

Microsoft Excel

Microsoft Word

Job description

Quadax, Inc. is seeking a detail-oriented insurance billing specialist for a remote position that requires 3 months of on-site training at our Middleburg Heights, Ohio facility. Applicants must reside in Ohio.

The role involves reviewing medical claims, managing prior authorizations, and communicating with insurance companies and physicians. Ideal candidates have prior health insurance billing experience, strong knowledge of medical terminology, and proficiency in Excel and Word.