Copy of Prior Authorization Specialist

About the role

We are looking for a strong writer with clinical experience to serve as an Authorization Escalation Specialist. This role is responsible for the successful completion of prior authorizations for Medical Equipment, acting as an advocate for patients to obtain approvals through the Department of Labor. The position requires high levels of organization, dedication, and persistence, with a focus on problem-solving, resolving confrontation, and overseeing daily functions of the authorization team. You will work closely with medical benefit examiners at the DOL, case managers, patients, and all internal departments.

Responsibilities

• Write letters of medical necessity, averaging 20 per day.
• Communicate daily via phone with insurance payers to gain prior authorization approval.
• Work with remote teams in multiple states.
• Understand and accurately apply requirements for prior authorization.
• Ensure eligibility and benefits are properly verified.
• Exhibit excellent customer service skills and serve as an advocate for the patient.
• Perform other related duties as assigned to maintain a high level of service.
• Demonstrate professional work behavior by following Service Standards and Success factors.
• Comply with departmental organizational policies, procedures, and external agency requirements.
• Ensure compliance with coding and billing regulations, including HIPAA and other industry guidelines.
• Maintain accurate and up-to-date documentation of job-related activities, including authorizations, claims, appeals, and communication internally and externally.

Requirements

• High school Diploma or equivalent required; Medical Assistant Degree, LPN, RN, or equivalent preferred.
• 2 years of medical experience highly preferred.
• Six months of experience with prior authorizations, federal and commercial preferred.
• Demonstrated work history of successfully writing, handling prior authorizations, appeals, and denials.
• Brightree Experience preferred.
• DOL Experience.
• Ability to meet U.S. employment and eligibility requirements.

Skills

• Strong writing skills.
• Excellent customer service and collaboration skills to optimize patient care and clinic operations.
• High degree of computer literacy in a PC environment.
• Strong organizational, interpersonal, and communication skills.
• Strong attention to detail and accuracy in data entry, documentation, and claims processing.
• Ability to handle confidential and sensitive information with discretion.
• Strong problem-solving and analytical skills to identify and resolve issues.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
• Knowledge of medical terminology, anatomy, diagnosis codes, and procedures.
• Ability to work independently in a remote setting while effectively managing team collaboration and project deadlines.
• Organized, proactive, and able to identify and address potential issues swiftly.