Prior Authorization Specialist
New
G
GeneDxHealthcare Genomics
Remote, Can support EST hours.Full-TimeMiddle
Salary29.56 - 33.8 USD per hour
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Job Details
- Experience
- 3-5 years of experience
- Required Skills
- SalesforceHIPAA
Requirements
- 3-5 years of experience in healthcare billing, focusing on prior authorizations and appeals.
- Strong understanding of insurance policies, medical terminology, and coding.
- Well-versed in insurance authorization and verification processes for major health plans.
- Strong communication and interpersonal skills.
- Experience using Google Apps, Mac OS X, and CRM applications.
- Understanding of industry-specific policies, such as HIPAA regulations.
- Ability to support EST hours.
- Exceptional attention to detail and organizational abilities.
- High school diploma preferred.
- Xifin, Salesforce, and careviso experience preferred.
Responsibilities
- Review and resolve Prior Authorization inquiries in Salesforce.
- Research accounts that require appeals for prior authorization denials.
- Prepare and submit appeals to insurance companies, including compiling necessary medical records and documentation.
- Review and resolve rejected authorizations.
- Communicate with healthcare providers and insurance companies to facilitate peer-to-peer review.
- Submit and track prior authorization requests using appropriate tools.
- Ensure documentation is complete and accurate to avoid delays.
- Collaborate with clinical teams, billing, and market access to resolve issues.
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