Pre-Authorization Specialist I - Remote, United States

Labcorp•Burlington, NC

2d•$18 - $19•Remote

About The Position

The Pre Authorization Specialist supports reimbursement and revenue cycle activities by conducting benefit investigations, reviewing payer medical policies, initiating, and managing prior authorizations, and providing patient cost estimates. This role partners with patients, health plans, clients, and internal stakeholders to ensure required authorization and coverage requirements are met while maintaining accurate documentation and supporting timely billing and reimbursement processes. The position is a first-shift remote role with flexibility in scheduling based on business needs.

Requirements

High school diploma with 2 or more years of experience in insurance claims processing, prior authorization, medical benefits verification, or healthcare reimbursement operations.

Nice To Haves

Associate degree or higher in Healthcare Administration, Business Administration, Health Information Management, or a healthcare-related field.
2 or more years of experience documenting healthcare authorization activities within authorization, billing, reimbursement, or revenue cycle management systems
2 or more years of experience working with Labcorp systems, including LCLS and/or LCBS.
2 or more years of experience in Revenue Cycle Management (RCM) operations.
1 or more years of experience using Microsoft Word, Excel, and Outlook in a healthcare, reimbursement, billing, or authorization environment.

Responsibilities

Research and review medical policies using Policy Reporter, payer websites, and other payer resources.
Contact health plans to verify patient insurance eligibility, benefits, and coverage information.
Initiate and manage prior authorization requests with health plans and payers.
Provide status updates on prior authorization requests to internal and external stakeholders.
Perform benefit investigations to support authorization and billing activities.
Prepare and deliver patient cost estimates based on insurance benefits and coverage information.
Request missing information from patients and clients and follow up to obtain required documentation.
Manage correspondence from clients, patients, and health plans regarding authorization and coverage requests.
Accurately document prior authorization activities within the designated prior authorization platform.
Prioritize work activities based on request urgency and business requirements.
Identify authorization, eligibility, and coverage issues and escalate concerns as appropriate.
Perform additional billing-related duties and other responsibilities as assigned.
Demonstrate effective customer service and customer relations practices when interacting with patients, clients, payers, and internal stakeholders.
Communicate authorization outcomes, benefit information, and status updates through verbal and written communications.
Apply time management practices to prioritize workload and meet established service levels.
Perform basic mathematical calculations including addition, subtraction, multiplication, and division.
Maintain attention to detail when reviewing medical policies, benefits information, authorization requirements, and documentation.
Collaborate with patients, clients, health plans, and internal teams to obtain required information and resolve authorization-related issues.
Escalate authorization, eligibility, coverage, and reimbursement concerns according to established procedures.