Revco Solutions Hiring for Prior Authorization Specialist at Remote Full Time

Apply today!!!! Full-Time Remote Prior Authorization Specialist

Our Company: Revco Solutions provides best-in-class Revenue Cycle management to Hospital and Physician Service clients.

Position Description: The Authorization Specialist is responsible for creating, tracking, and completing medical treatment authorizations requests for various insurances for patients who seek medical services. This role is required to utilize all available resources to verify eligibility, benefit levels, and patient copayment/coinsurance responsibilities.

Duties & Responsibilities:

• Verify patients medical plan benefits and requirements according to their specific medical policy, to ensure necessary procedures are covered by an individual’s provider and maximum payment for services rendered.
• Submit prior authorizations to insurances in timely matter via payer specific portals and vendors.
• Ensures all pertinent medical documentation is accurate and present prior to authorization submission to minimize financial risk.
• Follows up with insurance companies to ensure documentation has been received, the current status or to be informed of any action needed in order to obtain the authorization approval.
• Communicates any authorization denials to the appropriate staff.
• Handles any discrepancies, errors, or omissions of authorization denials and files appeals when necessary for overturn of adverse decision.
• Clearly document all communication and prior authorization documentation, in standardized documentation requirements, and save in Electronic Health Record (EHR) as appropriate.
• Obtains timely authorization of all patients requiring pre-certification and is accountable for conversion percentage and results.
• Follow through with payer correspondence and requests for more information related to each authorization and appeal submission.
• Gather required/additional supporting documentation and information, including state protocols, physician or hospital medical records, state or federal statutes, patient, or physician letters of medical necessity, etc.
• Communicate with physician offices, their staff/clinical contacts, and patients on the progress of their prior authorization or internal appeal requests.
• Build and maintain professional, cooperative relationships with all departments that have direct or indirect impact on obtaining authorizations.
• Clearly document all communications and contacts with payers, physicians, and families in standardized documentation requirements including proper format. Communicate effectively, timely and professionally in writing and verbally.

Requirements:

• Understands medical terminology and can speak to ICD-10 codes, CPT codes, and HCPCS codes.
• Experience submitting and managing prior authorizations, internal provider-based and/or member-based appeals, and external reviews with independent review organizations.
• Ability to recognize, evaluate, and solve problems and find solutions.
• Experience with Major Medical Insurance.
• Excellent oral and written communication skills.
• Demonstrates excellent organization skills with attention to detail.
• Proficient in Microsoft Office, including Microsoft Word, Outlook, and Excel.
• Experience in multi-tasking in multiple platforms and software programs, as well as equipment.
• Excellent Customer Service skills and interface with clients
• Work Schedule: Monday-Friday 8a-5p PST; 9a-7p CST; 10a-8p EST

What We Offer:

• Insurance/401k
• PTO/Paid holidays
• Referral bonuses

Job Type: Full-time

Pay: $16.00 – $19.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Application Question(s):

• Can you commit to the work schedule 8a-5p PST/9a-7p CST/10a-8p EST?
• Do you live in FL, IA, IN, MI, NC, NE, OH, PA, TX?

Experience:

• Insurance verification: 1 year (Required)
• prior authorization: 1 year (Required)
• Medical terminology: 2 years (Required)

Work Location: Remote