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Remote Optum Prior Authorization Jobs in Tennessee

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Remote Optum Prior Authorization information

What is a Remote Optum Prior Authorization?

A Remote Optum Prior Authorization job involves reviewing and processing requests from healthcare providers to determine whether certain medical procedures, medications, or services will be covered under a patient's insurance plan. Employees in this role work from home and use clinical guidelines to assess the necessity and appropriateness of requested treatments. They collaborate with providers, patients, and insurance teams to ensure timely authorization decisions. This position typically requires strong communication skills, attention to detail, and familiarity with healthcare regulations and insurance policies.

How does a Remote Optum Prior Authorization specialist typically interact with healthcare providers and insurance teams?

As a Remote Optum Prior Authorization specialist, you will regularly communicate with healthcare providers, pharmacies, and insurance representatives to obtain and verify necessary information for authorizing medical procedures or medications. Most interactions occur via phone, secure messaging, or electronic health record systems, requiring clear communication and attention to detail. Collaboration is essential, as you'll often need to clarify clinical documentation with providers and ensure compliance with insurance guidelines. This role is well-suited for those who are organized, proactive, and comfortable working independently within a supportive virtual team environment.

What are the key skills and qualifications needed to thrive as a Remote Optum Prior Authorization specialist, and why are they important?

To thrive as a Remote Optum Prior Authorization Specialist, you need strong knowledge of medical terminology, insurance processes, and prior authorization protocols, typically supported by a healthcare-related degree or relevant experience. Familiarity with electronic health record (EHR) systems, insurance verification tools, and prior authorization software is essential. Excellent attention to detail, organizational skills, and effective communication are vital soft skills for efficiently managing high volumes of authorization requests and collaborating with providers. These skills ensure accurate, timely approvals and help optimize patient care while reducing administrative delays.

What is the difference between Remote Optum Prior Authorization vs Remote Optum Claims Reviewer?

AspectRemote Optum Prior AuthorizationRemote Optum Claims Reviewer
CredentialsTypically requires healthcare-related certifications, such as RN, LPN, or medical coding credentialsOften requires similar healthcare certifications, with focus on claims processing
Work EnvironmentRemote, healthcare insurance setting, interacting with providers and patientsRemote, insurance claims processing environment, reviewing submitted claims
Employer & Industry UsageCommonly employed by health insurance companies like Optum, focusing on authorization processesEmployed by insurance companies, focusing on claims review and reimbursement

Remote Optum Prior Authorization specialists focus on obtaining approvals for healthcare services, while Remote Optum Claims Reviewers evaluate submitted claims for accuracy and reimbursement. Both roles require healthcare knowledge and certifications, but differ in their primary functions within the insurance process.

What are popular job titles related to Remote Optum Prior Authorization jobs in Tennessee?

For Remote Optum Prior Authorization jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Remote Optum Prior Authorization jobs in Tennessee look for?

The top searched job categories for Remote Optum Prior Authorization jobs in Tennessee are:

What cities in Tennessee are hiring for Remote Optum Prior Authorization jobs?

Cities in Tennessee with the most Remote Optum Prior Authorization job openings:

Remote Optum Prior Authorization jobs near you
Infographic showing various Remote Optum Prior Authorization job openings in Tennessee as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, 1% Temporary, and 3% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

Revenue Cycle Associate - Financial Clearance

Quorum Health

Brentwood, TN • Remote

Full-time

Medical, Retirement, PTO

Posted 16 days ago

Quorum Health rating

6.5

Company rating: 6.5 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

Job description

Revenue Cycle Associate - Financial Clearance

Employment Type: Full Time
Location:  Remote
Reports To: Manager, Financial Clearance

You must reside in one of these states to be eligible for this position:

Arkansas                  California                 Kentucky
Massachusetts                Nevada                    New Mexico
Oregon                  Utah                      Tennessee
Texas                     Wyoming

Job Summary:

The Revenue Cycle Associate, Financial Clearance position is responsible for ensuring that a patient’s visit is financially cleared prior to the date of service. The role includes verifying patient insurance eligibility/benefits, calculating patient liability estimates, securing prior authorization, providing notice of admission, obtaining referrals, and verifying medical necessity. These efforts will result in increased net revenues by reducing front-end related denial write-offs. Interactions will be conducted with providers, payers, patients, and hospital-based personnel. Duties are to be performed accurately and timely while providing exceptional customer service.

Key Responsibilities:

  • Ensures Financial Clearance (e.g., verification of eligibility/ benefits, securing prior authorization, etc.) is obtained timely prior to the patient’s date of service based on service line and departmental policies.
  • Performs coverage discovery using eligibility tools to identify additional insurance coverage if existing insurance on file is inactive.
  • Calculates and clearly documents patient liability estimates based on patient’s verified benefit information.
  • Provides payers with timely inpatient and observation Notices of Admission (NOA) as required based on payer-specific guidelines.
  • Validates prior authorization has been obtained and follows up with providers via phone as required for applicable services lines.
  • Verifies medical necessity for applicable patients and identifies instances where a Medicare Advance Beneficiary Notices of Noncoverage (ABN or NONC) is required.
  • Escalates instances where Financial Clearance may not be obtained (e.g., unable to obtain authorization) prior to patient’s DOS to appropriate stakeholders in accordance with departmental deferral policies.
  • Resolves insurance coverage and authorization information discrepancies as identified through automated quality assurance tool.
  • Works denials related to referral, authorizations, notifications, non-coverage, and medical necessity as assigned. This includes, but is not limited to, coordinating with appropriate stakeholders to submit rebills or appeals and obtaining retro authorization when required.
  • Observes privacy, safety, and security procedures, and uses equipment and materials properly.
  • Possesses the ability to work within a remote call center environment, free from distractions and background noise. 
  • Recognizes and consistently exhibits exceptional customer service as a critical factor in all duties performed.

Required Skills & Qualifications:

  • Proficient in typing.
  • General knowledge of medical terminology.
  • Ability to communicate effectively and professionally in English, both verbally and in writing. 
  • Critical thinking and problem-solving skills.
  • High school graduate or equivalent.
  • One year of related experience in the medical field is preferred. 

Benefits:

  • Competitive salary and benefits package.
  • Opportunities for professional development and advancement.
  • Supportive work environment with a collaborative team.
  • Comprehensive healthcare coverage.
  • Retirement savings plan.
  • Paid time off and flexible scheduling options.
  • Student loan repayment program.

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