Medical Prior Authorization Specialist - Hybrid

AC3 was founded by a group of oncologists who built solutions to optimize their own practices. Now, we give specialty health practices the power to make decisions with better data. Our mission is to help them thrive through people, purposeful technology, and collaboration. The work we do empowers healthcare practitioners and their teams to provide the highest quality of care in a sustainable way.

About the role

The prior authorization (also called “preauthorization” and “precertification”) position obtains approval of a health care service or medication before the care is provided. They work with the client, insurance, and patient to evaluate whether care is medically necessary and otherwise covered. This position obtains prior authorization for radiology exams, radiation therapy, procedures, and chemotherapy drugs, and is responsible for documenting and entering required information in our systems.

Responsibilities

• Understand insurance requirements for prior authorization
• Understand payer processes (website, fax, contact number) to submit appropriate authorization request
• Understand insurance billing procedures and practices
• Find and understand clinical information from EMR regarding services to be rendered
• Contact payers to obtain prior authorization
• Follow policy and procedures on treatment therapies and substitutions
• Advise providers and their clinical staff when issues arise relating to obtaining prior authorization
• Navigate and use national medical guideline tools
• Verify that all insurance requirements have been met before noting approvals
• Follow the workflow process on all pending cases
• Serve as primary contact with outside facility requests for our clients
• Respond to all client emails and calls within the agreed-upon policy timeframe
• Note and apply all authorization correspondence in both PM and EMR systems
• Maintain the practices and principles set forth by AC3 leadership with a strong commitment to service, excellence, and quality
• Maintain professional behavior, confidentiality, and discretion at all times, along with the ability to work with all levels of staff with a confident and professional demeanor
• Follow HIPAA rules and regulations
• Perform other duties as assigned

Requirements

• High school diploma or equivalent (GED)
• Medical office experience/medical terminology preferred
• Accurately maintain and adhere to all safety rules and regulations
• Must be detail-oriented and have problem-solving abilities
• Proficient in Microsoft Office preferred
• Working knowledge/experience in electronic medical records and/or other medical software if applicable
• Must possess the ability to work with patients and family members in a confident, respectful, and socially professional manner
• Must rely on experience and judgment to plan and accomplish goals
• Excellent communication and organizational skills with the ability to work in a fast-paced environment; prioritize tasks and workloads

Schedule

This is a full-time hybrid/remote position, requiring onsite training and a combination of remote and onsite work. The ideal candidate will reside within a 30-mile radius of the office located in South Bend, IN. Work is completed in a general office environment, sedentary in nature but may require standing and walking for up to 10% of the time.

Benefits

• Medical, dental, and vision health and wellness benefits
• Employer-paid life insurance
• Long and short-term disability policies
• Above-average paid time off plan
• Comprehensive wellness program, including onsite biometrics and ongoing mental and physical wellness support
• Access to company-sponsored financial wellness counselors
• Employee assistance services
• Company-matched 401k plan