Prior Authorization Specialist

About the role

Labcorp is seeking a REMOTE Prior Authorization Specialist to join our team!

Responsibilities

• Review incoming orders to verify completeness and accuracy of documentation required for prior authorization submission.
• Initiate and manage prior authorization requests in accordance with payer requirements and medical policies.
• Work directly with vendors, payers, and insurance representatives to facilitate successful prior authorization submissions.
• Monitor prior authorization request status, track pending cases, and perform follow-up activities to support timely determinations.
• Review insurance policies, medical policies, and payer guidelines to ensure authorization requests meet applicable requirements.
• Perform benefit investigations to support reimbursement and pre-billing activities.
• Respond to billing-related inquiries received through phone, email, chat, portal, and other communication channels.
• Provide prior authorization status updates and requirements information to providers, patients, and insurance representatives.
• Support resolution of authorization-related and billing-related issues.
• Maintain accurate records of prior authorization requests, approvals, denials, and related activities within designated databases and systems.
• Enter and maintain authorization, coverage, and benefits information in applicable platforms.
• Identify process improvement opportunities related to authorization and reimbursement workflows.
• Participate in projects and initiatives supporting operational improvements and business objectives.
• Manage assigned work schedules and changing business priorities.
• Maintain productivity and service-level expectations.
• Apply time management and organizational practices to manage workload and competing priorities.
• Maintain attention to detail when reviewing medical policies, insurance guidelines, documentation, and authorization requirements.
• Demonstrate knowledge of medical terminology, insurance guidelines, and healthcare regulations.
• Collaborate with team members and stakeholders to support process improvements and customer experience initiatives.
• Apply problem-solving practices in a fast-paced and evolving operational environment.

Qualifications

• Requires a High School or equivalent with minimum 2 years’ relevant experience.
• Successful completion of the Labcorp training sessions including Medical Terminology, Anatomy and Physiology along with passing the assessment of skill.
• Associate degree in Healthcare Administration, Business Administration, Health Information Management, or a healthcare-related field preferred.
• 1 or more years of experience in Clinical Laboratory Revenue Cycle Management (RCM) operations.
• 1 or more years of experience supporting prior authorization, reimbursement, billing, or benefits verification activities within a clinical laboratory environment.
• 1 or more years of experience using Microsoft Word, Microsoft Excel, and Microsoft Outlook in a healthcare reimbursement, billing, authorization, or revenue cycle environment.

About The Role

The Prior Authorization Specialist I supports Labcorp's Prior Authorization program by completing payer-required pre-billing activities that help ensure timely and accurate payment for services. Responsibilities include reviewing medical policies, initiating and managing prior authorizations, performing benefit investigations, providing patient cost estimates, maintaining authorization documentation, and responding to billing-related inquiries from clinicians and patients. This role partners with Sales, Operations, Billing, Laboratory teams, payers, providers, and patients to help meet authorization and reimbursement requirements while supporting positive patient and client outcomes.

Pay Range

$17.75 - $19.50 per hour.

Benefits

• Medical
• Dental
• Vision
• Life
• STD/LTD
• 401(k)
• Paid Time Off (PTO) or Flexible Time Off (FTO)
• Tuition Reimbursement
• Employee Stock Purchase Plan

About Labcorp

Labcorp is a global leader in diagnostic testing and drug development solutions, helping healthcare providers, researchers, and patients make informed decisions that advance care. Labcorp is proud to be an equal opportunity employer and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications and merit of the individual. Qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. Additionally, all qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law. We encourage all to apply.