Prior Authorization Specialist
Prior Authorization Specialist
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Job Description
Job Title: Prior Authorization Specialist
Location: Remote
Company: Janie Health
Employment Type: FullTime
Job Overview:
We are looking for a skilled and detailoriented Prior Authorization Specialistto manage the preauthorization and scheduling process for patient orders. In this role you will be responsible for gathering and verifying documentation liaising with referring physicians and working with insurance companies to ensure smooth and timely authorizations. The ideal candidate must have experience in pain management clinics and be wellversed in handling preauthorizations in this specialized area of healthcare.
Key Responsibilities:
Manage Incoming Patient Orders: Oversee the process of receiving patient orders ensuring all required information is collected for preauthorization and scheduling.
Documentation Collection: Gather necessary documentation from referring physicians and their offices and reach out for additional information or clarification when needed.
Order Evaluation: Review orders to assess whether they are likely to be approved for preauthorization and ready for processing.
Data Entry: Accurately enter clinical and nonclinical information into computer databases and insurance portals ensuring data integrity.
Clinical Data Review: Review clinical information and match it against specified medical criteria following established protocols for authorizing requests.
Insurance Coverage Verification: Evaluate incoming orders for completeness verifying that the ordered procedure is covered by the patients insurance.
FollowUp on Documentation: Contact referring physicians for orders still awaiting necessary documentation to ensure timely processing.
Obtain Missing Documentation: Reach out to physicians offices to secure missing documents required to complete patient orders.
Insurance PreCertification: Work with patients insurance companies to precertify and authorize procedures as ordered by the referring physician.
Monitor PreCertification Status: Continuously monitor the status of precertifications to ensure timely authorization and completion.
Qualifications:
- Prior experience with prior authorizations precertifications or insurance verification in a healthcare setting specifically in pain management clinics.
- Strong understanding of medical terminology and insurance processes.
- Proficient in data entry and using healthcare software/insurance portals.
- Excellent communication skills both written and verbal for interacting with physicians insurance companies and patients.
- Highly organized with the ability to manage multiple tasks and follow up on pending documentation.
- Strong attention to detail ensuring accuracy in patient orders and documentation.
Preferred Qualifications:
- Experience working remotely in a healthcarerelated administrative role.
- Familiarity with HIPAA regulations and patient data security.
- Experience handling multiple insurance providers portals and precertification processes.
Employment Type
Full Time
