Clinic Authorization Specialist

Progyny•New York, NY

6d•$28 - $31•Hybrid

About The Position

Thank you for considering Progyny! Progyny is looking for a detail-oriented Clinic Authorization Specialist to handle daily authorization requests for in-network clinics. The position entails answering a high volume of phone calls and emails. The successful candidate will be able to ensure an elevated level of customer service, maintain positive relationships within the network and maximize productivity by reviewing accuracy for data processing. The Clinic Authorization Specialist must be able to operate in a fast-paced environment, manage difficult conversations, be thoughtful, resourceful, collaborative, and customer focused.

Requirements

Prior experience required in a health care environment—knowledge of the fertility industry is preferred
Undergraduate degree
Prior experience using Microsoft excel and outlook, and Salesforce knowledge preferred
Ability to manage multiple priorities including understanding various insurance products and levels of benefit within each product.
Comfortable in an environment with data-driven goals with monthly performance feedback
Flexible and able to navigate change
Ability to manage difficult conversations
Knowledge of CPT, HCPCS, AND ICD-10 codes and understanding of medical terminology strongly preferred
Ability to work independently and demonstrate good judgment
Excellent interpersonal skills - ability to communicate accurately and effectively with internal and external stakeholders
Highly organized, quick learner, with ability to multitask and prioritize work effectively
Must be willing and able to work the 12pm-9pm EST shift
Please note: This is not a digital nomad or remote international position; candidates must be based in the United States.
Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship, now or in the future.

Responsibilities

Manage a high volume of provider calls and emails – time management and efficiency are critical.
Be passionate about providing the best possible provider and member experience at all times
Review and analyze complex fertility related authorization requests by navigating multiple systems and platforms and accurately capture the data/information for processing (e.g. verify prior authorizations, applicable benefits)
Communicate with providers regarding authorizations or required additional information for accurate authorizations
Interpret and enforce clinic contracts as it relates to covered services and authorizations; be a fearless and persuasive speaker in encouraging partner providers to maintain compliance with best practices and contractual guidelines; be able to overcome objections and ensure authorizations align with contractual guidelines
Be flexible and to adapt with evolving business needs

Benefits

Family friendly benefits: Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents’ Employee Affiliation Group
Menopause and midlife care
Health, dental, vision and life insurance options for employees and family
Free in-person, virtual and text-based mental health and wellness support
Paid time off, including vacation, sick leave, personal days and summer flex time
Company equity
Bonus program
401(k) plan with company match
Access to on-demand legal and financial advice
Learning and development programs to help you grow professionally and a mentorship program
Company social events to include annual volunteer day and donation matching
Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office