Reimbursement Specialist – Prior Authorization – AM – PM Cst – Monday – Friday Shift

Reimbursement Specialist – Prior Authorization – AM – PM Cst – Monday – Friday Shift

Requirements

• Three years of work experience in a healthcare environment focused on healthcare reimbursement
• Knowledge of health plan regulations and processes
• Moderate Excel skills, including the ability to sort, filter, and perform simple calculations
• Experience working with a broad range of payers
• Experience coordinating with insurance providers, physicians, and patients to obtain prior authorizations
• Experience appealing to state level agencies or external level review with IRO/IRBs

Responsibilities

• Contact insurance companies to secure preauthorization required for patients to receive services
• Ensure information obtained is complete and accurate, and follow up on requests
• Develop and maintain a database of payer authorization requirements
• Manage documentation for appropriate payer communication, correspondence, and insurance claim research
• Track, report, and address complex outstanding claims
• Troubleshoot EOBs, appeal non-covered and inappropriately adjudicated claims, and follow up on claims
• Drive positive coverage determinations through external appeals

Preferred Qualifications

• Familiarity with laboratory billing
• Familiarity with Xifin
• Familiarity with EDI enrollment
• Familiarity with merchant solutions
• Familiarity with payer portals
• Knowledge of national and regional payers throughout the country