Remote Prior Authorization Specialist

Must be able to work an Alaska time zone schedule.

About the role

The Care Coordination Representative is responsible for completing tasks related to assigned Care Coordination services (CCS) / Health Information Management (HIM) service. CCS services include e-Filing (electronic filing), order and referral management, insurance verifications, prior authorizations, and completing patient medical forms. This position may be onsite, hybrid and/or remote, allowing you to work from your own home office environment.

Responsibilities

• Process assigned tasks with a focus on accuracy, efficiency, and compliance with client protocols
• Evaluate medical documents and file them electronically into patient charts
• Navigate client electronic health records (EHR) software and internal systems with ease
• Handle high volumes of work with high quality and accuracy
• Utilize strong data entry and typing skills with ability to move quickly on a keyboard
• Cross-train in multiple EHRs to provide additional team coverage when needed
• Follow pre-defined filing processes; refer to company internal documentation or ask your supervisor for assistance in filing documents properly
• Understand and utilize assigned clients’ protocols and Service Level Agreement
• Track completed work to log time and transaction counts on an hourly basis or as directed by management
• Know the Planning Guidelines (PGLs) or Target Transactions per Hour for the client accounts you are working on
• Complete all work as assigned by management
• Report to management any reasons for a variance to standard, including all issues preventing or delaying planned job completion, and report any actions taken to resolve
• Study and continually reference internal documentation and protocols
• Exercise confidentiality concerning the affairs of the business and follow HIPAA guidelines and procedures; report all HIPAA violations and maintain good HIPAA practices
• Provide exemplary customer service to all, including external customers, vendors, visitors, coworkers, and management, with clear and effective communication, professionalism, and courtesy while representing the company
• Attend any meetings or training as required
• Understand and comply with company/client agreed compliance standards
• Perform other duties, as assigned, to ensure effective operation of the department and the Company

Requirements

• High School Diploma or equivalent required
• Experience with health information management concepts, EHRs, and/or medical terminology is a plus
• Proficient in managing a high-volume, fast-paced environment with accuracy
• Intermediate computer skills, including Microsoft Office Suite and the ability to adapt to company-specific software
• Capable of efficiently navigating multiple open programs, windows, and applications
• Strong attention to detail and accuracy
• Able to perform physical tasks such as sitting, talking, hearing, using hands, reaching, standing, walking, driving, and occasionally lifting up to 25 lbs
• Occasional after-hours or weekend work may be required
• Able to fulfill responsibilities in a remote capacity while ensuring access to strong/reliable internet within a designated, secure, and private workspace