Remote Prior Authorization Specialist

Alliance Health System; Bloomfield (NJ); Hybrid; USD 34,000 - 36,000; Full time

Benefits offered by this job

401(k) matching

Health insurance

Paid time off

Paid Holidays

Job summary

Alliance Health System in Bloomfield is seeking an Authorizations Specialist to obtain prior authorizations for all treatment by successfully completing the authorization process with commercial, automobile and workers' compensation payers. This full-time role can be remote or hybrid, and reports to the Director of Authorizations.

You will review chart documentation for medical policy adherence, prioritize requests by urgency, and manage payer files.

Qualifications

• High School Diploma or GED required.
• 2 years medical prior authorization experience preferred.
• 2 years experience with MD providers - Orthopedics & Pain preferred.

Responsibilities

• Review chart documentation to ensure patient meets medical policy guidelines.
• Prioritize incoming authorization requests according to urgency.
• Obtain authorization via payer website, fax or by phone and follow up regularly on pending submission.
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations.
• Initiate appeals for denied or modified authorizations.
• Respond to clinic questions regarding payer medical policy guidelines; Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order.
• Other duties as assigned.

Skills

Authorization knowledge

Payer guidelines

CPT/ICD-10 coding

Excel

Adobe

Internet

Customer service

Time management

MD provider experience

Education

High School Diploma or GED

Job description

Alliance Health System in Bloomfield is seeking an Authorizations Specialist to obtain prior authorizations for all treatment by successfully completing the authorization process with commercial, automobile and workers' compensation payers. This full-time role can be remote or hybrid, and reports to the Director of Authorizations.

You will review chart documentation for medical policy adherence, prioritize requests by urgency, and manage payer files.