Prior Authorization Specialist (WFH) (Work from Home)

Position Summary:

We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our growing team. In this role, you will be responsible for verifying insurance eligibility, following up on prior authorizations, and ensuring that all necessary documentation is in place for accurate billing. The successful candidate will possess excellent communication and organizational skills, as well as the ability to work independently and as part of a team.

Job Details:

- Work from home
- Monday to Friday | 9:00 PM to 6:00 AM Manila Time
- *Following US Holidays

Responsibilities:

- Monitor, track prior authorization statuses, and follow up on authorization requests to ensure timely processing and approval.
- Coordinate with facilities and the Utilization Review (UR) team to manage cases.
- Ensure timely and efficient communication through emails and other correspondence.
- Verify insurance eligibility and benefits for patients, ensuring all information is accurate and up to date.
- Maintain thorough and accurate records of all prior authorization requests, approvals, and denials.
- Communicate effectively with healthcare providers, patients, and insurance companies to resolve any issues related to prior authorizations and insurance verification.
- Collaborate with other team members, including medical billers and coders, to ensure efficient and accurate billing processes.
- Stay informed on the latest changes and updates to insurance policies, procedures, and regulations, applying this knowledge to the prior authorization process.

Qualifications:

- Minimum of 2 years' experience in medical insurance verification, prior authorization, or a related role in the US Healthcare Industry.
- Experience in behavioral health and substance use disorder facilities (PHP and RTC levels of care preferred) is required.
- Familiarity with medical terminology, diagnostic codes (ICD-10), and procedure codes (CPT). Knowledge of insurance policies, procedures, and regulations, including Medicare, Medicaid, and private insurance companies
- Strong computer skills, including proficiency in Microsoft Office Suite and electronic health record systems.
- Candidates must have excellent written and verbal communication skills and be well-versed in crafting punctual and professional emails.
-Strong organizational skills and attention to detail, with the ability to manage multiple tasks and prioritize effectively.
-Ability to work independently and as part of a team in a fast-paced, deadline-driven environment.
-Experience working with electronic health record (EHR) systems, medical billing software, and insurance verification tools.