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Prior Authorization Specialist
locations
Alpharetta – Windward Pkwy
Remote – Alaska
Remote – Alabama
Remote – Maryland
Remote – Maine
View All 51 Locations
time type Full time
job requisition id R31219
Change Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities.
Work Location
- Fully Remote – U.S.
Position
- The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures, medications, surgery and outpatient radiology testing.
Core Responsibilities
- Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements
- Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services
- Manage correspondence with insurance companies, physicians, specialist, and patients as needed, including documenting in the EHR as appropriate
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
- Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial
- Prioritize the incoming authorizations by level of urgency
- Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations
- Communicate any insurance changes or trends among team
- Maintains a level of productivity according to established internal metrics
- Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
- Other duties as assigned.
Requirements
- High school diploma or equivalent
- Knowledge of CPT and ICD coding highly desired
- Knowledge of Medicare, Medicaid and third-party payer guidelines highly desired
- Good judgment, tact, diplomacy, and ability to problem solve
- Effective customer relation skills, ability to organize and interpret data
- Knowledge of EMR systems (Cerner/Powerchart, Meditech, EPIC, etc.).
Preferred Qualifications
- Previous experience in a clinic setting preferred
- Knowledge of insurance process and medical terminology highly desired
- PACS certification desired.
Working Conditions/Physical Requirements
- General office demands
- Must have a high speed internet connection and a quiet place to work remotely (equipment needed to work from home is provided by Change Healthcare).
Unique Benefits*
- Flexible work environments
- Ready, Set, Grow Career Development Center & access to Change Healthcare University for continuous professional learning & development with more than 5,000 training assets
- Volunteer days, employee giving and matching gifts programs, community awards and dollars for doers, community partnerships
- Employee wellbeing programs and generous health plans
- Educational assistance programs
- US 401(k) or Group RRSP (Canada) savings plans with matching employer contributions
- Be sure to ask our Talent Advisors for more information on location specific benefits and paid time off policies
- *Eligibility for some benefits may be limited or not available for part-time employees, be sure to speak with your Talent Advisor.
California / Colorado / New Jersey / New York / Rhode Island / Washington Residents Only:
The applicable base pay for your state is listed below. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, Change Healthcare offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with Change Healthcare, you’ll find a far-reaching choice of benefits and incentives.
The base pay range for this position is $13.07 – $29.02