Reimbursement Specialist - West Coast

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Requirements:

• High School diploma, Certified Professional Coder or 2-year degree from an Accredited Medical Billing School preferred.
• 1-3 Years of direct billing experience.
• Familiarity with ICD and HCPC/CPT coding preferred.
• Familiarity with CMS 1500 claim form preferred.
• Familiarity with Claim Adjustment Reason Codes (NUCC) preferred.
• Strong analytical, interpersonal, communication, organizational, numerical, and time management skills.
• Ability to quickly assess situations and respond to customer needs efficiently.
• Excellent written and verbal communication skills.

Responsibilities:

• Processing of prior authorization cases via Glidian, eviCore and direct health plan portals.
• Knowledge in insurance payor authorization guidelines, and follow-up of authorization status from health plan.
• Researching and responding to heavy authorization caseload in a timely manner.
• Reviewing and providing an analysis of prior authorization determination denials and approvals.
• Organizing and maintaining comprehensive files that include health plan prior authorization turnaround time, appeal guidelines, and other pertinent information.
• Reviewing medical records and responding to health plan clinical questions.
• Researching and monitoring health plan issues, trends, and potential risks, providing feedback to managers.
• Providing administrative support including data entry and updating record-keeping systems.
• Knowledge and compliance with all applicable laws and regulations.