Remote Prior Authorization Specialist (Healthcare)

Taleo; Corvallis (OR); Remote; USD 25,000 - 44,000; Full time

Job summary

The Corvallis Clinic is seeking a Referral and Prior Authorization Specialist to join our team in Corvallis, OR. This full-time role, Monday–Friday, 8:00am–4:30pm PST, involves coordinating authorizations, submitting documentation to insurers, and ensuring timely processing.

Remote in Oregon with onsite training; must be able to work in-office when needed and comfortably use Outlook/Teams. Salary ranges from $18 to $32 hourly, based on experience and market.

Qualifications

• High School Diploma/GED or equivalent years or work experience.
• Must be 18 years of age OR older.
• 2+ years of experience in a medical office.
• 2+ years of experience interacting with insurance companies.
• 2+ years of ICD-10 and CPT coding knowledge.
• Computer proficiency (including Microsoft Outlook, Teams) and be able to use multiple web applications.
• Basic level of computer proficiency including Microsoft Word (create, edit, save) and Microsoft Excel (create, sort, view, filter)
• Ability to be on camera for meetings during work hours.
• Ability to work full-time, Monday - Friday. Employees are required to work during our normal business hours of 8:00am - 4:30pm PST. It may be necessary, given the business need, to work occasional overtime.

Responsibilities

• Efficiently obtains all authorizations for medical procedures to be performed prior to patients scheduled date of service.
• Processes authorizations and submit clinical supporting documentation to insurance carriers.
• Documents all prior authorization information including approval dates, prior authorization number in patient chart.
• Reads medical documentation and does medical chart review prior to requesting authorization.
• Notifies scheduling and clinical staff of delays in obtaining these authorizations.
• Ensures that insurance carrier documentation requirements are met and authorization documentation is scanned and documented in the patient’s medical record.
• Completes follow-up as needed with physicians, clinical staff, and insurance companies.
• Monitors authorization requests to ensure timely processing and completion.
• Communicates approvals and denials to the ordering physician and assists with any denials or issues to resolve.
• Reviews denials and submits appeals if requested by physician in an effort to obtain approval by insurance companies.
• Researches, corrects, and re-submits rejected and denied claims.
• Informs supervisor about any changes or patterns when working denials of procedures.
• Collaborates with other departments to assist in obtaining pre-authorizations in a cross-functional manner.
• Ability to handle high workload volume timely and accurately.
• Performs other duties as assigned

Skills

Communication skills

Customer service

ICD-10 CPT coding

Microsoft Outlook

Education

High School Diploma/GED

Tools

Microsoft Teams

Microsoft Word

Microsoft Excel

Job description

The Corvallis Clinic is seeking a Referral and Prior Authorization Specialist to join our team in Corvallis, OR. This full-time role, Monday–Friday, 8:00am–4:30pm PST, involves coordinating authorizations, submitting documentation to insurers, and ensuring timely processing.

Remote in Oregon with onsite training; must be able to work in-office when needed and comfortably use Outlook/Teams. Salary ranges from $18 to $32 hourly, based on experience and market.