Prior Authorization Representative

Title: Program Coordinator1 - Prior Authorization/Claims Processor

Location: 100% REMOTE Mcallen, TX

Duration: months contract

Target Start Date (based on successful onboarding completion): ASAP

Shift: 8:00 AM - 5:00 PM(subject to change and possibility of over time according to business needs)

Walk me through the day-to-day responsibilities of this the role and a description of the project:

• The Centralized Authorization Team consists of the processing of authorizations for LTSS, in which we are now at a 3-4 BD TAT for the processing of LTSS/ SK/SH/MMP authorizations. We will utilize project temps/contingent workers to assist with each of these areas as well as cross train them to be able to assist in multiple functions. The authorization team continues to experience a high task and authorization volume as the number of VIP providers has increased.

Describe the performance expectations/metrics for this individual and their team:

• Excellent attendance (especially during training)
• Daily goals are being met
• Daily production trackers must be completed and emailed to a designated person at the end of your shift
• Multi-tasking with multiple monitors and applications
• Utilize work guides and or resources
• 97% Quality (Audits)
• 98% Production
• 0-5% Error Rate

Tell me about what their first day looks like:

• Welcome call from the Supervisor
• Training Courses
• Shadow mentor/training via zoom screen share

What previous job titles or background work will be in this role?

• 2 years of medical experience in authorizations or claims processing practices in a managed care setting. Knowledge of customer service, medical terminology, and operation of office equipment.

Required Skills/Experience/Education:

• 2+ years of RECENT Authorizations or Claims Processing in managed care setting experience
• Knowledge of customer service, medical terminology, and operation of office equipment.
• Strong Proficiency in Microsoft Office, Computer Skills, Tech Savvy and Multitasking skills
• High School Diploma or GED required.

Job Type: Contract

Salary: $18.00 per hour

Expected hours: No less than 40 per week

Benefits:

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

Weekly day range:

• Monday to Friday
• Weekends as needed

Experience:

• Authorizations or Claims Processing Healthcare: 2 years (Required)

Ability to Commute:

• McAllen, TX (Required)

Work Location: Remote