Prior Authorization Specialist
About You
You are a person passionate about working closely with Patient, Patient Access, Payers, and Providers' office to validate insurance plans, eligibility, and orders to procure required prior authorizations. Tell us about your experience with Prior Authorization.
Are you a team player and a self-motivator?
About The Position
We are counting on you to manage multiple projects using your problem-solving skills.
We are looking for someone UNCOMMON. What is uncommon about you? Are you highly committed? Are you team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we cannot wait to meet you.
About The Position
Collaborate with insurers to obtain pre-authorizations for condition-specific medications, diagnostic procedures and treatments, and support patients in navigating barriers / coverage and disputes.
Submit prior authorization requests for medical procedures, diagnostic tests, treatments, and medications as required by insurance providers.
Gather, review, and submit all necessary clinical documentation to support authorization requests, ensuring accuracy and completeness.
Communicate with insurance representatives to clarify requirements, resolve authorization denials, and follow up on pending approvals.
Collaborate with physicians, nurses, and other clinical staff to obtain additional clinical information or documentation required by insurance companies.
Inform patients about the status of their authorization requests, answer questions regarding coverage, and provide guidance on next steps.
Maintain accurate and detailed records of all prior authorization requests, outcomes, and patient information in compliance with HIPAA regulations.
Stay updated on changes in insurance policies, state and federal regulations, and organizational policies affecting prior authorizations and reimbursement.
Meet quality and productivity standards set by Signature and/or our client.
Provide excellent customer service in keeping with Signature's legacy both internally and externally.
Maintain expertise in multiple current client systems.
Maintain up-to-date knowledge of revenue cycle management, industry trends, and perform other duties as necessary.
Acts as an effective team member.
Minimum Requirements
- Minimum of 2 years' experience in EPIC EMR/HER.
- Minimum 2 years of prior authorization experience, insurance coordination, or case management within a physician office, hospital, or insurance plan authorizations unit.
- Understanding of healthcare insurance systems.
- Strong written and verbal communication skills with the ability to explain complex medical and insurance information.
- Strong attention to detail.
- Passion for patient advocacy with a problem-solving mindset, focusing on overcoming challenges to accessing care.
- Ability to work effectively both independently and as part of a multidisciplinary team.
- Computer proficiency including Microsoft Office, Word, Excel and Outlook.
- Function effectively in a fast-paced environment.
- Personal traits of a high level of commitment, motivation, energy, team orientation, professionalism, trust, personal honesty, and integrity, and a demonstration of placing others in a place of high value.
Preferred Requirements
- Preferred experience and understanding of medical terminology.
- General knowledge of CPT/HCPCS and ICD-10.
About Us
You are uncommon. We are, too. We are looking for people to help us in our mission of working hard at lowering healthcare administrative costs for federal government agencies, payers, and providers.
At Signature, our mission is to improve the health of our clients' business and make the lives of the people we work with better.
As we continue to experience exponential growth, we are looking for uncommon individuals to enhance our vision.
We will continue to accomplish our mission by leading with our values of Passion, Courage, Integrity, and Respect in all interactions, making us a consistent annual Best Places to Work organization.
We need uncommon leaders with uncommon qualities to shape our uncommon culture and achieve our uncommon mission.
About The Benefits
- Health Insurance
- Fully Paid Life Insurance
- Fully Paid Short- & Long-Term Disability
- Paid Vacation
- Paid Sick Leave
- Paid Holidays
- Professional Development and Tuition Assistance Program
- 401(k) Program with Employer Match