Remote Eligibility and Prior Authorization Specialist

Summary

Join our team as an Eligibility and Prior Authorization Specialist and play a key role in building and maintaining collaborative relationships with internal and external stakeholders, managing revenue cycle projects, and driving performance in operations related to reimbursement.

Requirements

• Proficiency with medical billing systems, Microsoft Excel, medical terminology and basic procedure coding knowledge
• Knowledge of medical terminology and abbreviations, and health care nomenclature and systems
• Strong communication (verbal and written), organizational, problem solving and team player skills
• Ability to navigate across multiple customer demands and balance competing priorities successfully
• Ability to analyze, identify and articulate identified trends and report trends succinctly in a clear and concise manner
• Ability to solve problems using critical thinking skills
• Maintains confidentiality of sensitive information
• Analytical skills required
• Ability to think critically and identify the impact across the revenue cycle with a solution oriented approach
• Ability to develop, implement and produce analysis and reports

Responsibilities

• Serves as a source of knowledge for the designated revenue cycle function
• Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for the designated revenue cycle function
• Responsible for developing appropriate workflows and tracking for the designated revenue cycle function
• Establishes an ongoing working relationship with other departments impacting revenue cycle performance
• Works closely with various vendor operations teams (Prior authorization, Claims and Appeals) to oversee operations activity that directly impacts the revenue cycle to accurately process actions in a timely manner for optimal reimbursement
• Tracks outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met
• Leads weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities
• By continually reviewing and monitoring eligibility and prior authorization changes, researches, evaluates, and interprets guidance from a variety of sources to determine departmental actions
• Coordinates with Management to ensure thorough understanding of trends/issues affecting revenue cycle performance
• Develops goals and metrics to link department and revenue cycle initiatives with the organization's strategy
• Develops, manages and monitors successful completion of implementation and project plans
• Acts as an educator on performance improvement requirements in operations and methodologies to related teams and departments
• Continuously seeks new and creative technologies that help identify and guide improvement opportunities that align with overall company success

Benefits

• Comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents
• Free testing in addition to fertility care benefits
• Pregnancy and baby bonding leave
• 401k benefits
• Commuter benefits