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100% Remote!
This is an hourly PRN (as needed) position, and the hours will vary based on the needs of the department.
Bachelor's degree in Nursing, Health Administration, or related field is required. Experience in Cardiology pre-authorizations, utilization review, or case management is highly desired.
Our team assists healthcare providers with the remediation of 3rd party accounts receivable, call center support and a variety of revenue cycle outsource capabilities.
In this position, you will be responsible for providing clinical justifications for pre-authorization requests to ensure that patients receive timely and appropriate care, you will collaborate with healthcare providers and insurance companies to facilitate the authorization process, utilizing your clinical expertise to support the necessity of medical services.
Responsibilities:
- Clinical Justifications:
- Review medical records and other documents to provide comprehensive clinical justifications for pre-authorization requests
- Ensure that all justifications are based on current clinical guidelines, best practices, and evidence-based medicine
- Pre-Authorization Process:
- Submit pre-authorization requests to insurance companies, ensureing all required information is included
- Track the status of submitted pre-authorizations and follow up as needed to ensure timely approval
- Collaboration and Communication:
- Work closely with physicians, nurses, and other healthcare professionals to gather necessary clinical information
- Communicate effectively with insurance companies to address any questions or concerns regarding pre-authorization requests
- Documentation and Compliance:
- Maintain accurate and detailed records of all pre-authorization requests and outcomes
- Ensure compliance with all relevant laws, regulations, and organziational policies
- Problem Solving:
- Address and resolve any issues or discrepancies related to pre-authorizations
- Provide recommendations for process improvements to enhance the efficiency and effectiveness of the pre-authorization process
- Bachelor's degree in Nursing, Health Administration, or related field. Advanced clinical degrees preferred (e.g., RN, NP, PA).
- Minimum of 2 years of clinical experience in a healthcare setting
- Experience in pre-authorizations, utilization review, or case management is highly desirable
- Strong clinical knowledge and the ability to interpret medical records and documentation
- Excellent communication and interpersonal skills
- Detail-oriented with strong organizational skills and time-management abilities
- Proficiency in using electronic health records (EHR) and other healthcare-related software
TRC Talent Solutions is proud to be an Equal Opportunity Employer (EOE). All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
