INSURANCE authorization specialistRemoteVA

Job Description
Our agency, Remote VA PH, is currently looking for an experienced Insurance Authorization Specialist. An Insurance Authorization Specialist plays a critical role in the healthcare and insurance industry, ensuring that medical procedures, treatments, and services are authorized and approved by insurance companies.
Job Title: Insurance Authorization Specialist
Work Schedule: Monday to Friday ( 9 AM to 6 PM Eastern Standard Time)
Job Summary:
The Insurance Authorization Specialist is responsible for obtaining pre-authorization or prior authorization from insurance companies for medical procedures, tests, treatments, and services. They work closely with healthcare providers, insurance companies, and patients to ensure necessary approvals are obtained in a timely and efficient manner.
Key Responsibilities:
Creating and managing all of the insurance authorizations for each patient's episode of care.
Verify Insurance Coverage: Confirm patients insurance coverage and benefits to determine pre-authorization requirements and coverage limitations.
Review Medical Documentation: Evaluate medical records and supporting documentation to ensure they meet the criteria set by insurance companies for authorization.
Initiate Authorization Process: Communicate with healthcare providers to gather the necessary information and documents needed for authorization requests.
Prepare Authorization Requests: Complete and submit pre-authorization requests to insurance companies, ensuring accuracy and compliance with insurance guidelines.
Follow-Up and Advocacy: Monitor the status of authorization requests and follow up with insurance companies to expedite the approval process, providing additional information if required.
Communicate with Healthcare Providers: Collaborate with healthcare providers to address any issues or discrepancies related to authorization requests and facilitate timely resolution.
Educate Patients: Educate patients on insurance authorization processes, requirements, and potential financial implications, ensuring they are well informed throughout the process.
Maintain Records: Document all authorization-related activities and maintain accurate records of authorization requests, approvals, denials, and appeals.
Compliance and Regulations: Stay informed about insurance policies, regulations, and guidelines related to authorization processes to ensure compliance and adherence.
Reporting: Generate and provide regular reports on authorization statuses, approval rates, and any issues encountered during the authorization process.
REQUIREMENTS:
Prior experience with Insurance Authorization is required.
Experience with EMRs
Knowledge of insurance and creating authorizations for several health plans.
Preferred knowledge of Fidelis, Agewell, UHC
Required knowledge of Medicare, and Medicaid.
Comfortable communicating with patients and Doctors Offices
Proficiency with Google Suites, ePACES, and Excel
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