Prior Authorization Specialist

Summary

Emerge Pediatric Therapy is looking for a full time Prior Authorization Representative to add to their growing team! This person would act as an assistant to the Billing Manager and our primary internal contact for all client insurance authorizations.

Our mission is to enhance the lives of the children we serve and the families who love them by providing a fun, nurturing, and supportive therapeutic environment. https://emergepediatrictherapy.com/

Responsibilities

The Prior Authorization Representative's purpose is to manage all submissions for authorization of therapy services. This includes timeline management, submission oversight, submission follow up, and detailed record keeping to ensure that clients do not have gaps in benefit coverage. This may be accomplished in the following ways:

• Verifying eligibility of patients insurance prior to approval to ensure for reimbursement
• Submitting initial and concurrent authorizations to Medicaid, Medicaids Managed Care Organizations (MCOs), and Tricare
• Submitting initial and concurrent authorizations for commercial insurance payers as needed
• Completing necessary documentation and submissions for clients to obtain out-of-network coverage agreements
• Making outbound calls to insurance companies, patients and physician offices as needed
• Coordinates and follows up with clinical and office staff to ensure completion of required documentation
• Accurately inputs Prior Authorizations and maintains client files in company EHR system
• Any other tasks delegated by the Billing Manager after provided with the proper training

Skills and Qualifications

• Knowledge of NC Medicaid and Medicaid Managed Care Organizations payers as it relates to documentation and reimbursement requirements
• Knowledge of Tricare as it relates to documentation and reimbursement requirements
• Extremely organized with a strong attention to detail
• Ample technology skills: related to electronic documents, spreadsheet related work, and web portal navigation
• Ability to work remotely
• Flexible with the ability to adapt quickly to changes
• Exhibits responsibility and professionalism
• Great communication skills
• Desire to learn and advance skill set
• Driven to reach goals/targets
• Effective and efficient problem solver
• Excellent attendance record and punctuality
• Likes to work in a fast paced environment with others
• Enjoys the pediatric population and their families