Key Responsibilities
- The Prior Authorization Specialist will be responsible for the following core duties:
- Prior Authorization Submission and Monitoring:
- Monitor the Prior Authorization queue and manage an organized list of outstanding and in-progress PAs
- Review patient and service data provided by the biller/clinical team for completeness and accuracy
- Submit new prior authorizations to the correct insurance company and plan efficiently via the required method, including insurance portals, fax, or telephone
- Status Follow-Up:
- Proactively and consistently call insurance companies to check on the status of submitted prior authorizations to prevent processing delays
- Document all communication and status updates clearly and promptly in the patient management system
- Denial Management and Appeals:
- Identify, prepare, and submit prior authorization denial appeals in a timely manner, gathering all necessary clinical and administrative documentation
- Track the status of all submitted appeals through resolution
- System and Documentation Updates:
- Monitor the designated fax inbox or electronic queue for prior authorization approvals, denials, and requests for additional information
- Promptly update the patient management system with the final PA status, authorization number, and expiration date upon receipt of approval
Key Skills
- Exceptional Attention to Detail: Crucial for accurately submitting data and preparing appeals.
- Strong Communication Skills: Excellent verbal and written communication skills for professional interaction with insurance representatives and clinical staff
- English Speaking: Fluency in English is required to effectively communicate with insurance representatives and team members.
- Organizational and Time Management Skills: Ability to prioritize a high volume of PA requests and follow-up tasks under deadlines
- Problem-Solving: Resourcefulness in troubleshooting issues with insurance company portals or processes.
- Team Player: Ability to work collaboratively with billing and clinical teams to achieve patient care goals.
Optional
- Medical billing experience
- Familiarity with various commercial and government payer systems (e.g., Medicare, Medicaid, and major commercial insurers)
- Proven knowledge of medical terminology, CPT codes, and ICD-10 codes
What We Do
Welcome to 1840 & Company. We are changing the way companies hire, manage, and grow their workforce. Our mission is leading the future of work towards a more flexible, inclusive, and efficient global job market, enabling businesses worldwide to overcome staffing and skills challenges with ease and efficiency. As a global leader in business process outsourcing (BPO) and staff augmentation, we offer comprehensive solutions that span from Recruitment Process Outsourcing (RPO) to global compliance and payroll services. Our approach reduces traditional hiring costs by up to 70%, offering a scalable, cost-effective solution for businesses at any growth stage. At the core of our strategy is an advanced AI-driven talent matching system, part of our 1840 Global Talent Cloud, which ensures quick and precise placement of vetted professionals in over 150 countries. This unique capability allows us to provide quality staffing solutions rapidly, addressing the dynamic needs of today's businesses. 1840 & Company is more than just a BPO provider; we are a strategic partner committed to adding value and enhancing productivity. By managing the complexities of international staffing and operations, we enable our clients to focus on their core missions with the confidence that their outsourcing needs are in expert hands. Visit our website at www.1840andco.com to learn more and request a free consultation on scaling your company's growth with global remote talent.
