Remote Prior Authorization Specialist

Alliance Health System; Matawan (NJ); Hybrid; USD 50,000 - 55,000; Full time

Benefits offered by this job

401(k) matching

Health insurance

Paid time off

Paid Holidays

Job summary

Alliance Health System seeks an Authorizations Specialist to secure prior authorizations for treatments across commercial, auto, and workers' compensation payers. Location options include REMOTE or HYBRID, reporting to the Director of Authorizations, with a focus on efficient processing to support revenue cycle.

Responsibilities include reviewing medical records, initiating authorizations, following up with payers, and maintaining accurate documentation.

Qualifications

• Knowledge of treatment authorization and its impact on revenue cycle.
• Understanding of payer medical policy guidelines for authorizations.
• Proficient use of CPT and ICD-10 codes.

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 payer files with up-to-date requirements for 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

Payer authorization knowledge

CPT/ICD-10 coding

Detail oriented

Time management

Customer service

Microsoft Excel

Education

High School Diploma or GED

Tools

Adobe Acrobat

Microsoft Excel

Internet browser

Job description

Alliance Health System seeks an Authorizations Specialist to secure prior authorizations for treatments across commercial, auto, and workers' compensation payers. Location options include REMOTE or HYBRID, reporting to the Director of Authorizations, with a focus on efficient processing to support revenue cycle.

Responsibilities include reviewing medical records, initiating authorizations, following up with payers, and maintaining accurate documentation.