100% Remote

Pay: $18-22/hour

Our team assists healthcare providers with the remediation of 3rd party accounts receivable and a variety of revenue cycle outsource capabilities.
We are seeking a highly organized and detail-oriented individual to join our team as a Remote Insurance Authorization Specialist. In this role, you will be responsible for obtaining prior authorizations from insurance companies for upcoming medical procedures, treatments, and services for patients while providing accountable oversight of assigned work que; processes procedures and projects in order to deliver superior productivity and quality outputs for the assigned client. You will work closely with our client, healthcare providers, insurance companies, and patients to navigate the authorization process efficiently. This position may transition to Accounts Receivable Representative for future projects, based on ongoing needs.

Responsibilities:

Communicates with insurance companies to obtain prior authorizations for surgeries, imaging studies, procedures, and other services
Verifies insurance eligibility and benefit information
Initiates timely prior authorization requests with insurance plans either by phone or payer portal
Submits medical documentation needed to obtain prior authorizations
Requests medical records, updated orders, and insurance information from providers when appropriate
Monitors work list for urgent scheduling add-ons to secure prior authorizations
Coordinates peer-to-peer requests with insurance plans and the ordering providers
Demonstrates persistence when obtaining authorization status from insurance carriers
Updates the patient accounting system with authorization numbers for specified services and date spans
Notifies Scheduling and ordering providers of any delays or rescheduling needs due to payer delays
Understand payer policies related to authorization requirements and timeframes needed to obtain authorizations
Appropriately respond to phone calls, emails, and other forms of communication
Complies with governmental regulations in reference to healthcare, billing, the Health Insurance Portability and Accountability Act (HIPAA), the Joint Commission (TJC) standards, Centers for Medicare and Medicaid Services (CMS), Emergency Medical Treatment and Labor Act (EMTALA), as well as department policies and procedures

Other Functions:

Provides courteous service to all stakeholders (patients, patient families, other department staff, etc.) by resolving stakeholder problems, responding to inquiries, and following-up and strengthen customer relationships
Assist in training of new hires as needed
Perform other duties as assigned or requested and job specifications can be modified or updated at any time

Qualifications:

High School Diploma or equivalent
Proficient with Microsoft Office Products
Proficient typing and spelling
Proficient computer skills, multitasking with data entry while using multiple computer applications
Ability to provide high level of customer service, attention to detail, critical thinking, and have proficient written and verbal communication skills

Preferred Qualifications:

Some college experience in healthcare, business, accounting and/or professional certification preferred
Associates degree and/or bachelor's degree in medical preferred
Prior authorization experience in a healthcare setting
Knowledge of ICD-10 and CPT codes as well as other medical terminology
Have an understanding and ability to communicate financial and insurance information

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.