Prior Authorization Specialist

Boulder Care

2d • $23 - $25 • Remote

About The Position

The Prior Authorization Specialist is responsible for obtaining all pre-authorizations for medication approvals. They will work closely with staff to review, research and complete prior authorizations, prior authorization appeals, and notify patients of status updates from insurance. The most important goal is to improve patients' medication adherence by offering a quick and effortless way for patients to get their medications on time.

Requirements

• A minimum of 6 months of experience working on prior authorizations
• 2+ years of Medical office/clinic experience
• Ability to organize workload and manage time effectively
• Technologically savvy
• Ability to read and interpret medical benefits for verification requests
• Ability to handle a high volume of work with speed and accuracy
• Passion for helping people
• Ability to work closely with our care team to ensure the success of patients that are recommended to us by their physician's office
• Team player that can also solve problems independently
• Exceptional written and verbal communication skills
• Reliable, and a self-starter
• Access to reliable, high-speed internet to meet the needs of remote processing
• Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.

Nice To Haves

• Medical Assistant experience
• Customer service experience
• Remote/telehealth experience
• A passion for serving the needs of people with addiction and mental health challenges, using non-stigmatizing, non-judgmental person-first language

Responsibilities

• Obtain prior-authorization for all patients requiring insurance approval for medication needs
• Verify patient insurance information is accurate and documented correctly
• Troubleshoot prior authorization submissions and prescription processing with health care providers utilizing phone or online resources
• Review and resolve all reported authorization issues timely and effectively
• Submit prior authorizations to insurance plans in a timely manner via payer-specific portals, fax, or verbally via phone
• Communicate authorization and benefit coverage with patients and providers promptly and professionally
• Obtain appropriate documentation to validate the approval or denial of authorizations
• Document progress of prior authorization appropriately using our operating system
• Follow up on pending authorizations on a regular basis to obtain the current status or to be informed of any action needed in order to obtain the authorization approval
• Successfully navigate between multiple systems throughout the course of the workday, this includes but is not limited to operational software and payer portals
• Maintain patient file security and confidentiality by adhering to appropriate confidentiality and HIPAA policies and guidelines
• Advise management of identified trends with payers in an effort to mitigate problems

Benefits

• Comprehensive medical, dental, vision, and short-term disability benefits designed to take care of our employees and their families
• Mental Health Services via insurance coverage including Talkspace and EAP for continuous care
• 4 weeks of vacation accrued per calendar year with a tenured increase to 5 weeks at 2 years of employment
• Sick leave accrued at 1 hr for every 30 hrs paid
• 9 Paid Holidays per year
• 12 weeks of 100% paid parental leave for the birth or adoption of a child (after 6 months of employment)
• 401(k) retirement savings

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed