Remote Prior Authorization Rn Jobs in Mason, OH (NOW HIRING)

Job Title: Insurance Authorization Specialist

Must reside in the following states: AL, AZ, FL, GA, IL, IN, KS, KY, MI, MN, MO, NC, NJ, OH, OK, PA, TX, VA

Job Summary

The Intake Specialist - Insurance Authorization is responsible for timely, accurate and comprehensive review of patient schedules. Coordinates and effectively communicates with appropriate personnel regarding insurance carriers, business office services to ensure quality patient care and appropriate reimbursement. Also obtains the appropriate Pre-Authorization and Referral information, including verification of patient insurance, from physician offices and insurance carriers.

Duties and Responsibilities

 File requests for prior authorization for all insurances that require based upon plan or insurance contract
 Request, obtain, and document all prior authorizations (or denials of same) appropriately and in a timely manner
 Obtain information about patient insurance coverage, benefits and eligibility
 Maintain and update internal listing of insurance carriers that require authorization
 Run system-generated reports to verify procedures by insurances requiring authorization are being captured
 Assist collection team with obtaining retro authorizations
 Coordinate with Call Center and Optical Offices on prior authorization and patient billing activity
 Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements
 Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
 Performs other duties that may be necessary or in the best interest of the organization.

Education, Licensure & Certification Requirements

High School Diploma or GED

Experience Requirements

2+ years' experience medical authorizations

Knowledge, Skills and Abilities Requirements

 Comprehensive understanding of insurance verification, contract benefits and medical terminology
 Ability to enter data into various electronic systems while maintaining the integrity and accuracy of the data
 Ability to function effectively under stress of conflicting demands on time and attention, while successfully meeting deadlines
 Excellent organization, time management, and prioritization skills
 Professional in appearance and actions
 Logical and Critical thinking skills
 Enjoys learning new technologies and systems
 Detail oriented, professional attitude, reliable
 Exhibits a positive attitude and is flexible in accepting work assignments and priorities
 Meets attendance and tardiness expectations
 Management and organizational skills to support the leadership of this function
 Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
 Interpersonal skills to support customer service, functional, and teammate support need
Able to communicate effectively in English, both verbally and in writing
Ability to clearly articulate a response using appropriate voice modulation
Ability to maintain control of a call de-escalating issues and instilling confidence that a resolution will be found
 Ability for basic to intermediate problem solving, including mathematics
 Basic to intermediate computer operation
Proficiency with Microsoft Excel, Word, PowerPoint and Outlook
 Specialty knowledge of systems relating to job function
 Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

Location/Work Environment:
For on-site team members, work takes place in a normal office/clinical environment. Travel to other locations may be necessary to fulfill the essential duties and responsibilities of the job. Thus, those needing to travel for work must have access to dependable transportation, and their driving record must meet company liability carrier standards.
For remote team members, HIPAA compliant home office environment. Ability to work in a remote environment while performing required duties and remaining patient focused. Able to work varying shifts including early mornings/evenings to attend meetings and cross training or support other initiatives.