Prior Authorization Specialist

Triton Medical Solutions

7h•Remote

About The Position

Triton Medical Solutions is a medical billing and revenue cycle management company based in Tempe, Arizona, supporting practices nationwide in dental, orofacial pain, TMJ, dental sleep medicine, and CBCT radiology billing medical insurance. The Prior Authorization Specialist coordinates and obtains prior authorizations from insurance companies to help ensure patients receive timely access to medically necessary services and procedures. This remote, full-time independent contractor position involves approximately 40 hours per week, with flexible scheduling subject to agreed-upon work requirements and deadlines. The contractor uses their own computer that meets Triton Medical Solutions’ IT requirements. The role requires extensive time on the phone with insurance companies.

Requirements

High school diploma.
Knowledge of insurance cards, medical insurance terminology, medical benefits, and CPT and ICD-9/10 coding.
Ability to work independently, pay attention to detail, prioritize, and perform several tasks at once without losing concentration.
Ability to follow established procedures.
Excellent typing and computer skills, including proficiency in Microsoft Word and Excel.
Good oral and written English communication skills.
Well organized and detail-oriented.
Ability to relate to people from diverse backgrounds and provide excellent customer service.
Must provide a computer that meets the company’s IT requirements.

Nice To Haves

1–2 years in a customer-service-oriented environment.
1–2 years working in the insurance industry in a provider’s office, insurance company, or company involving employee benefits.

Responsibilities

Review procedure requests to determine authorization requirements based on insurance standards, using experience and general knowledge.
Review documentation or contact providers to supplement orders and establish medical necessity.
Contact physician offices or customer service departments to resolve issues involving missing vital patient-record information.
Contact insurance carriers to obtain required prior authorizations.
Submit authorizations with correct CPT and diagnosis codes.
Review denied prior authorizations and take corrective action.
Maintain up-to-date information about insurance companies and relevant changes.
Handle incoming and outgoing calls with internal team members, insurance payers, and customers regarding clinical documents and insurance benefits.
Provide quality customer service to clients and solutions to problems.
Work cordially with the team and participate in meetings, sharing ideas and information.
Participate in projects and meetings and complete other tasks assigned by the Team Leader or management.
Maintain strict confidentiality and adhere to HIPAA guidelines and regulations.