Prior Authorization Specialist

Signature Performance, Inc.•,

9h•Onsite

About The Position

This position involves collaborating with insurers to obtain pre-authorizations for condition-specific medications, diagnostic procedures, and treatments. The specialist will support patients in navigating barriers, coverage issues, and disputes. Key responsibilities include submitting prior authorization requests, gathering and submitting clinical documentation, communicating with insurance representatives, and collaborating with clinical staff. The role also involves informing patients about authorization status, maintaining accurate records in compliance with HIPAA, staying updated on insurance policies and regulations, meeting quality and productivity standards, providing excellent customer service, maintaining expertise in client systems, and staying knowledgeable about revenue cycle management and industry trends. The specialist will also act as an effective team member.

Requirements

Minimum of 2 years' experience in EPIC EMR/HER.
Minimum 2 years of prior authorization experience, insurance coordination, or case management within a physician office, hospital, or insurance plan authorizations unit.
Understanding of healthcare insurance systems
Strong written and verbal communication skills with the ability to explain complex medical and insurance information
Strong attention to detail
Passion for patient advocacy with a problem-solving mindset, focusing on overcoming challenges to accessing care.
Ability to work effectively both independently and as part of a multidisciplinary team
Computer proficiency including Microsoft Office, Word, Excel and Outlook
Ability to function effectively in a fast-paced environment.
Personal traits of a high-level commitment, motivation, energy, team orientation, professionalism, trust, personal honesty and integrity, and a demonstration of placing others in a place of high value.
U.S. Citizenship, or naturalized citizenship is required for this position.
All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.

Nice To Haves

Preferred experience and understanding of medical terminology
General knowledge of CPT/HCPCS and ICD-10

Responsibilities

Collaborate with insurers to obtain pre-authorizations for condition-specific medications, diagnostic procedures and treatments, and support patients in navigating barriers / coverage and disputes.
Submit prior authorization requests for medical procedures, diagnostic tests, treatments, and medications as required by insurance providers.
Gather, review, and submit all necessary clinical documentation to support authorization requests, ensuring accuracy and completeness.
Communicate with insurance representatives to clarify requirements, resolve authorization denials, and follow up on pending approvals.
Collaborate with physicians, nurses, and other clinical staff to obtain additional clinical information or documentation required by insurance companies.
Inform patients about the status of their authorization requests, answer questions regarding coverage, and provide guidance on next steps.
Maintain accurate and detailed records of all prior authorization requests, outcomes, and patient information in compliance with HIPAA regulations.
Stay updated on changes in insurance policies, state and federal regulations, and organizational policies affecting prior authorizations and reimbursement.
Meet quality and productivity standards set by Signature and/or our client.
Provide excellent customer service in keeping with Signature's legacy both internal and externally.
Maintain expertise in multiple current client systems.
Maintain up to date knowledge of revenue cycle management, industry trends perform other duties as necessary.
Acts as an effective team member.