Pre-Auth Specialist - Remote

Pre-Authorization Specialist – Remote Position

Basic Purpose:

The Pre-Authorization Specialist position is responsible for supporting the Prior Authorization program at Labcorp by assisting with pre-billing tasks required by payers as a condition of payment for services provided. The Pre-Authorization Specialist reviews medical policies, completes benefit investigations, initiates prior authorizations, provides cost estimates to patients, communicates outcomes with stakeholders, identifies trends, escalates issues, and performs other billing-related tasks.

Duties and Responsibilities:

• Identify prior authorization and/or referral requirements for the requested testing using internal and/or payer resources
• Research/review medical policies via Policy Reporter, payer websites, etc.
• Contact health plans to verify patient insurance eligibility, benefits, and coverage
• Obtain referral and or prior authorization details obtained by PCP when applicable
• Contact the ordering provider to request medical documentation to support the prior authorization request
• Ensure all pertinent medical documentation is secured/available before authorization submission
• Initiate prior authorization with health plans via payor-specific portals, by fax or telephone
• Manage correspondence from clients, patients, health plans and internal teams
• Clearly and accurately document activities related to prior authorization efforts in the prior authorization platform(s)
• Follow up on clinical note requests and or prior authorization requests from clients and or payors
• Answer inbound phone calls related to prior authorizations and or billing questions
• Prioritize workload based on the urgency of requests
• Provide status updates from payors on prior authorization requests
• Utilize all tools and applications to effectively and efficiently secure prior authorization
• Other duties as assigned

Qualifications:

• Previous experience in a clinical setting preferred
• Knowledge of insurance process and medical terminology preferred
• Proficiency in Microsoft Office (Word, Excel, Outlook)
• Effective customer relations skills
• Time management skills
• Excellent verbal and written communication skills
• Basic math skills required (add, subtract, divide, multiply)
• LCLS and/or LCBS experience preferred but not required
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures, including HIPAA regulations
• Maintains a level of productivity suitable for the department

License/Certification/Education:

• High School or equivalent and with a minimum of 2 years of experience
• Associate degree in business, Finance, Healthcare Administration or related field a plus

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer

Remote Technical Requirements:

• Must have a high-speed internet connection and a private, quiet place to work remotely (equipment needed to work from home is provided by Labcorp)
  • Internet speed of at least 50 megabytes per second
  • No satellite internet
• Ability to connect equipment to router/modem with an Ethernet cord
  • Equipment cannot be connected through Wi-Fi

Schedule:

• Ability to work the following schedule: Monday-Friday 8:30am – 5:00pm EST

Benefits: All job offers will be based on a candidate’s skills and prior relevant experience, applicable degrees/certifications, as well as internal equity and market data. Regular, full-time or part-time employees working 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(K), ESPP, Paid time off (PTO) or Flexible time off (FTO), Commissions, and Company bonus where applicable. For more detailed information, please click here.

Pay Range: $17.47-$25.56

Application Window open through March 27, 2024.

Labcorp is proud to be an Equal Opportunity Employer:

As an EOE/AA employer, Labcorp strives for diversity and inclusion in the workforce and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications of the individual and do not discriminate based upon race, religion, color, national origin, gender (including pregnancy or other medical conditions/needs), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. We encourage all to apply.

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