Prior Authorization Team Member

Eventus WholeHealth; Clarksville (TN); Remote; USD 30,000 - 50,000; Full time

Job summary

A leading healthcare company seeks a Prior Authorization Team Member to ensure efficient processing of authorization requests. This role involves collaboration with healthcare providers, maintaining accurate records, and implementing process improvements. A high school diploma and preferred experience in prior authorization are required. The position offers career growth potential and a focus on work/life balance, with employment benefits including medical insurance and PTO.

Benefits

Career growth potential

Work/life balance focus

Annual PTO for full-time employees

Medical, Dental, Vision, and Life Insurance

401K availability

Short-term and long-term disability insurance

Competitive pay with performance reviews

Reimbursement for continued education

Qualifications

• High School diploma required.
• Preferred 3 years of experience in a prior authorization role.
• Strong understanding of prior authorization processes.

Responsibilities

• Ensure timely and accurate processing of prior authorization requests.
• Coordinate with healthcare providers and insurance companies.
• Conduct regular audits and implement quality control measures.

Skills

Analytical skills

Communication skills

Problem-solving

Understanding of healthcare regulations

Education

High School diploma

Tools

Healthcare management software

Job description

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• Ensure timely and accurate processing of prior authorization requests.
• Develop and implement process improvements to enhance efficiency and accuracy.
• Monitor workflow and adjust as needed to meet departmental goals and deadlines.
• Ensure compliance with all applicable policies, procedures, and regulatory requirements.
• Collaboration and Communication:
• Coordinate with healthcare providers, insurance companies, and other stakeholders to resolve issues and facilitate approvals.
• Communicate effectively with team members, management, and external partners.
• Data Management and Reporting:
• Maintain accurate records of prior authorization requests and outcomes.
• Utilize data to identify trends and areas for improvement.
• Quality Assurance:
• Conduct regular audits of prior authorization requests to ensure accuracy and compliance.
• Implement quality control measures to minimize errors and improve service delivery.
• Address and resolve any identified issues promptly.
  

• Key Responsibilities:
• Process Oversight:
• Ensure timely and accurate processing of prior authorization requests.
• Develop and implement process improvements to enhance efficiency and accuracy.
• Monitor workflow and adjust as needed to meet departmental goals and deadlines.
• Ensure compliance with all applicable policies, procedures, and regulatory requirements.
• Collaboration and Communication:
• Coordinate with healthcare providers, insurance companies, and other stakeholders to resolve issues and facilitate approvals.
• Communicate effectively with team members, management, and external partners.
• Data Management and Reporting:
• Maintain accurate records of prior authorization requests and outcomes.
• Utilize data to identify trends and areas for improvement.
• Quality Assurance:
• Conduct regular audits of prior authorization requests to ensure accuracy and compliance.
• Implement quality control measures to minimize errors and improve service delivery.
• Address and resolve any identified issues promptly.
  

Qualifications

• Education:
  
  

High School diploma

• Experience:
  
  

Three years of experience in a prior authorization role is preferred.

• Skills and Abilities:
• Strong understanding of prior authorization processes and healthcare regulations.
• Strong analytical and problem-solving abilities.
• Exceptional communication and interpersonal skills.
• Proficiency in healthcare management software and systems.
• Ability to work in a fast-paced, dynamic environment.
• Working Conditions:
• This position may require occasional evening or weekend hours to meet departmental needs.
• The role is primarily remote, with some potential for office and field work depending on organizational policies and team meetings.
• Physical Demands:
• Must be able to travel to locations.
• Routine use of standard office equipment such as computers and phones.
• Ability to lift up to 25 pounds.
• Standing, walking, bending, kneeling, and stooping as required.
Benefits


• Career growth potential.
• Work/life balance focused company.
• PTO annually for qualifying full-time employees.
• Medical, Dental, Vision, and Life Insurance.
• 401K (available for part-time and full-time employees).
• Short-term and long-term disability insurance.
• Competitive pay with annual performance reviews and merit-based raises.
• Reimbursement available for continued education and conferences

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Management and Manufacturing

• Industries

  Hospitals and Health Care

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