We are seeking a detail-oriented and efficient Remote Prior Authorization Specialist to join our team. In this role, you will be the bridge between our practice and insurance carriers, ensuring that patient treatment plans are authorized promptly and accurately. You will manage high-volume authorization workflows through various digital portals and telephonic outreach, ensuring compliance and minimizing claim denials.
Core Responsibilities:

• Authorization Management: Actively manage the end-to-end authorization lifecycle for various insurance plans, including UHC, Fidelis, Aetna, Hamaspik, and Centers.
• Portal Proficiency: Navigate complex insurance web portals daily to submit and track authorization requests efficiently.
• Telephonic Outreach: Proactively contact insurance health plans when portal submissions require clinical review or further clarification to expedite approvals.
• Documentation Compliance: Coordinate with medical staff to secure all necessary clinical supporting documentation, including prescriptions/scripts and clinical notes, to ensure authorization success.
• Denial Management: Follow up on pending or denied requests, identifying the root cause and coordinating with the clinical team to provide requested information.

Required Qualifications & Technical Skills:

• Experience: Proven experience in a medical office or insurance verification role, specifically focusing on Prior Authorizations.
• Portal Expertise: Demonstrated proficiency in the following systems (Must have experience with at least two):
  • UHC Provider Portal
  • Availity Portal
  • Cohere Portal
• Communication: Excellent verbal and written English skills, with the ability to communicate professionally with insurance representatives over the phone.
• Reliability: Proven ability to manage high-volume workloads in a fully remote environment while maintaining strict attention to detail.