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Prior Authorization Specialist (Remote, Contract Only)
We are seeking a detail-oriented and motivated Prior Authorization Specialist to join our team in a fully remote capacity, on a temporary basis. This role is critical to the revenue cycle, ensuring that insurance authorizations, benefits, and price estimates are accurately secured before patients receive care.
You will be part of a dynamic team supporting five facilities across multiple specialties, including Radiology, Infusion/Injections, and Surgery. While you will be assigned specific facilities, you will also support our "sister facilities" to ensure seamless operations across the network.
Position Overview
- Work Hours: 9:00 AM - 5:00 PM EST
- Location: 100% Remote
- Volume: Approximately 1,700 - 2,000 cases per month (Average annual volume of 20,230)
- Software: All work is managed through EPIC work queues.
- Authorization & Verification: Initiate and follow up on authorizations for inpatient and outpatient services (Radiology, Infusion, Surgical, Diagnostic/Procedural Cardiology, etc.).
- Payer Relations: Interact directly with payers to verify benefits and secure notice of admissions. You will work with NY State Medicare, Wellcare, Fidelis, Humana, Aetna, and United Healthcare.
- Financial Clearance: Aim to achieve a 95% financial clearance rate at least one day prior to service, with a long-term goal of clearing cases 14 days out.
- Data Accuracy: Utilize EPIC eligibility reports to verify insurance and document all "touches" accurately.
- Efficiency: Maintain a production pace of 6-12 minutes per touch to meet a goal of 80% of total KPI targets.
Must-Haves:
- Proficiency with EPIC (Experience with EPIC work queues is essential).
- Prior experience or strong understanding of Insurance Authorizations.
- Solid command of Medical Terminology.
- Experience specifically within Radiology, Infusion, or Surgical specialties.
Note on Experience: While specific years of experience in this exact role aren't required, you must be comfortable navigating healthcare portals. On-the-job training for specific portal setups and workflows will be provided.
* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
* As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
