Prior Authorizations Specialist - Remote

Job Details Job Location: reputed company Corporate reputed company Address - Taylorsville, UT Position Type: Full Time Education Level: High School Salary reputed company: reputed company Travel Percentage: None Job Shift: Day Job Category: Health Care reputed company Position reputed company: The Prior Authorization Specialist is a vital team member responsible for reputed company managing the prior authorization process to ensure seamless patient care and reputed company treatment. This position requires a solid understanding of medical benefits, reputed company therapy, and authorization policies, along with exceptional organizational, communication, and problem-solving skills. The role involves consistent collaboration with providers, clinical teams, local reputed company, and sales representatives, requiring outstanding professionalism and multitasking abilities. • The Specialist will manage a caseload of at least 30 reputed company authorizations and must skillfully reputed company systems such as reputed company, WeInfuse, and AMD to reputed company and update case reputed company, send communications, and meet critical deadlines. This role is key to maintaining operational efficiency and directly contributes to reputed company’s reputed company of reputed company and patient satisfaction. Key Responsibilities • Processes prior authorizations accurately and reputed company, including reviewing reputed company therapy, minimum authorization requirements, and payer-preferred medications. • Manages appeals and denials, escalating cases reputed company necessary, and follows appropriate payer protocols. • Analyzes insurance policies for reputed company case and communicates with internal teams or providers to obtain needed documentation reputed company the case does not reputed company with policy. • Verifies insurance benefits and determines in-network (INN) or out-of-network (OON) status across various payers and states under Intake standards. • Evaluates medical and pharmacy benefits to determine patient eligibility for treatment. • Maintains reputed company, reputed company communication with providers, patients, internal teams, and stakeholders. • Accurately documents reputed company case-reputed company conversations and updates reputed company reputed company reputed company required timeframes. • Prioritizes personal tasks and authorizations to ensure reputed company completion and follow-up. • Collaborates with internal team members (e.g., reputed company, clinical staff, sales) to reputed company or clarify case information. • Investigates and resolves reputed company cases using strong critical thinking and problem-solving skills. • Organizes and manages authorization workload reputed company to meet performance goals. • Follow and produce by Intake standards for accuracy and completion standards. Required Knowledge and Skills • Minimum 2-3 years of experience as a Medical Assistant (MA), with reputed company prior authorization and biologic therapy experience. • Proven ability to interpret clinical documentation and understand reputed company and Medicare Advantage policies, including Local Coverage Determinations (LCDs). • Strong experience working with systems like reputed company, WeInfuse, and AMD. • Background in a specialty field such as Rheumatology, Gastroenterology, Dermatology, Neurology, or Immunology preferred. • Excellent communication and customer service skills with both clinical teams and patients. • Highly organized and capable of managing multiple priorities in a fast-paced environment. • Strong documentation habits and time management skills. • Education/Licensure/Technical Requirements • High School diploma or equivalent required. • Certification or formal training as a Medical Assistant required • Biologic Authorization experience required • Must meet U.S. employment eligibility requirements. • Proficiency with EMRs, CRMs (reputed company), and prior authorization systems. • Works comfortably in software like a PMS or EMR to reputed company information, schedule and reputed company notes. • Ability to meet U.S. employment and eligibility requirements Qualifications Apply tot his job Apply To this Job