Prior Authorization Assistant Healthcare

Job Description

This is a remote position.

Job Highlights:

• Contract type: Independent Contractor
• Night Shift Schedule: Monday to Thursday - 8:45am to 5pm New York Time (8:45pm - 5am Manila Time)
• Friday - 8:45am to 3:45pm New York Time (8:45pm - 3:45am Manila Time)

The Authorization Representative I (Auth Rep I) is responsible for doing well in training and becoming highly proficient in the timely, accurate submission, follow-up, and approval of Authorization Requests from the Accounts. The Auth Rep I is responsive, helpful, curious, eager to do her best, a good team member, and capable of achieving excellence for the Accounts.

Performance Expectations:

• 100% of Auths submitted within 24 hours of receiving the required information.
• 100% Auths Approved, Denied, and Completed within the carrier's turnaround time (excluding denials, appeals, and complex Auths).
• 100% client satisfaction rating.
• Master the key responsibilities listed below.

Key Responsibilities:

• Shows ability to grasp concepts and processes during training to gain the skills necessary to be proficient.
• Seek knowledge through curiosity and self-training in payer portals.
• Monitor Auth requests within our set 24 hour turnaround time.
• Perform Authorization requests with accuracy and efficiency.
• Ensure compliance with client preferences and payer rules.
• Prepare and submit Auths that result in Approvals (denials should be an exception).
• Respond to all inquiries within our set 24 hour turnaround time.
• Be accessible to Accounts and team members during normal work hours.
• Maintain accurate records and update client systems with authorization details promptly.
• Track and follow up on unapproved authorizations timely.
• Identify and address expiring authorizations to prevent disruptions in care.
• Assist with special projects, problem-solving, and process improvements.
• Escalate to Auth rep II immediately any requests you cannot or are not authorized to resolve.
• Participate in weekly meetings with Account teams and Coordinators
• Complete reports as required.
• With your Account Coordinator, create and maintain Rocks.
• Follow team processes at all times.

Core Values:

We hire/fire/promote based on these core values + job-specific performance.

1. Respectful of our unique cultural environment

2. Absolute confidentiality

3. Embracing teamwork

4. Loyal behavior and positive attitude

5. Accountability

6. Pro activeness

7. Thoroughness

8. Focused on results

9. Inspired to learn and grow constantly

10. Devoted to providing top-tier services to our clients through the company's "Unique Service Oriented Philosophies"

Requirements

• 2-year college degree
• 2-year experience in US-based medical billing practice or 2-year experience in a medical practice dealing with billing including but not limited to, provider credentialing, authorizations, reimbursement, etc. preferably in Behavioral Health to some degree
• Must have backup power supply (extra laptop/power bank/generator/UPS)
• Detail orientated with above-average organizational skill
• Able to plan and prioritize to meet deadlines
• Excellent verbal and written communication
• Communicates clearly and effectively
• Excellent reading comprehension
• Excellent computer skills, including Microsoft programs such as Excel, Word
• Thorough understanding of navigating the internet

Benefits

Independent Contractor Perks

• Permanent work from home
• Immediate hiring

Please note that since this is a permanent work-from-home position and an “Independent Contractor” arrangement, the candidates must have their own computer and internet connection. They will handle their own benefits and taxes. The professional fees are on hourly rates and the rate depends on your performance in the application process.