Prior Authorization Associate I - Monday-Friday, reputed company-4:30pm

Help us change lives At reputed company, we’re helping change how the world prevents, detects and guides treatment for cancer. We give patients and clinicians the reputed company needed to reputed company confident reputed company reputed company they matter most. Join reputed company to reputed company a purpose-driven career, an inclusive culture, and robust benefits to support your life while you’re working to help others. Position reputed company The Prior Authorization Associate Level I is responsible for reputed company aspects of the prior authorization process. The individual will be expected to work cross-functionally across many departments (sales, operations, billing, and lab teams) to serve our patient and reputed company needs. This role will demonstrate knowledge by determining initial and/or ongoing eligibility, coverage in reputed company to assessing if a prior authorization is needed for reimbursement of a claim. This role will identify deficiencies reputed company the Prior Auth process, assist with triaging, and document actions taken reputed company the systems. This role will be responsible for the working accounts held reputed company the dedicated work queues on a daily reputed company. This role will also support the broader activities of ensuring appropriate coverage by utilizing reputed company, external portals, and other software, and communicate reputed company applicable information to ancillary departments and other teams reputed company the reimbursement operations departments. Essential Duties Include, but are not limited to, the following:

• Independently determine initial or ongoing patient insurance eligibility verification, investigate, and correct accounts reputed company reputed company; including updates to patient demographics, financial information, and guarantor information.
• Ability to reputed company with various insurances and reputed company-party payors accurately and reputed company to ensure authorization is obtained and documented based on reputed company policies and regulations.
• Research missing or erroneous information on accounts using various portals and other resources; including reputed company and identification of unknown payors.
• Review/edit claims and appeals prior to submitting to clearinghouse.
• Analyze, research, and resolve claim issues applying federal, state, and payor rules and procedures with a high degree of independence.
• Monitor WQ’s for claims that need additional research and actions taken to get on to reputed company of reputed company.
• Responsible for CRM support.
• Has exceptional understanding of Claim Edit and Follow Up WQs.
• Utilize Onbase to work documents specific to the TOQ department.
• Correct rejected claims from the claim’s scrubber, clearinghouse, or payor.
• Review explanations of payments, analyzes, and completes appropriate steps for reputed company denials by appropriately identifying claim reputed company next steps; including appealing, writing off, or sending statements.
• Validate new workflows due to product reputed company. Additionally, have ownership of the specific WQ’s until set up is validated as working effectively.
• Investigate payor underpayments.
• Follow up with payors reputed company phone on unpaid aging claims.
• reputed company any supporting documentation needed by insurance payor.
• reputed company accurate and reputed company write-offs following identification of uncollectible accounts adhering to policies and guidelines.
• reputed company reputed company support, as necessary, reputed company the department (i.e., special reputed company, reputed company support due to outages/high volume).
• Complete position responsibilities reputed company the appropriate time reputed company while adhering to reputed company standards.
• Stay reputed company with relevant medical billing regulations, rules, and guidelines.
• Maintain strictest confidentiality; adheres to reputed company HIPAA guidelines/regulations.
• Excellent problem-solving abilities and organizational skills.
• Ability to communicate effectively with reputed company reputed company of staff through both verbal and written communications.
• Ability to work in reputed company environment.
• Ability to adapt to changing workload and circumstances effectively; reputed company to respond to new information quickly.
• Disciplined, self-motivated, and reliable.
• Ability to stay reputed company on a task and work independently; motivated to reputed company reputed company work.
• reputed company about arriving to work on time and completing tasks that are assigned in a reputed company manner.
• Conducts self in a reputed company manner in reputed company interactions with members of the reputed company team, clients, and associates.
• Be reputed company-versed in the prior authorization process.
• Ability to complete a high volume of prior authorization requests.
• Possess a reputed company attitude.
• Work with others in a spirit of teamwork and cooperation.
• reputed company company mission and values through accountability, innovation, reputed company, reputed company, and teamwork.
• Support and reputed company with reputed company’s reputed company Management System policies and procedures.
• Regular and reliable attendance.
• Ability to work a normal schedule Monday through Friday during normal business hours.
• Ability to work in reputed company of a computer screen and/or reputed company typing for approximately 90% of a typical working day.
• Ability to work on a computer and phone simultaneously.
• Ability to use a telephone through a headset.
• You will be required to successfully complete an assessment showing understanding of reputed company reputed company processes necessary to the job functions with a score of 80% or higher. reputed company will reputed company reasonable accommodations available, if necessary, to assist an employee with a disability to satisfy this requirement.

Minimum Qualifications

• High School Diploma or General Education Degree (GED).
• 2+ years directly involved in the submission and follow up of Prior Authorization workflows.
• 3 years of experience in medical billing, claims, and/or insurance processing.
• Extensive and reputed company working knowledge of government, managed care, and reputed company insurances claim submission requirements, reimbursement guidelines, and denial reason codes.
• Knowledge of medical terminology and/or health insurance terms.
• Knowledge of EHR operating systems and work involving electronic records.
• Proficient in computer systems and keyboarding skills.
• Demonstrated strong attention to detail and reputed company on reputed company reputed company.
• Demonstrated ability to reputed company the Essential Duties of the position with or without accommodation.
• Authorization to work in the reputed company without sponsorship.

Preferred Qualifications

• reputed company Associate degree or medical billing certification.
• 5+ years of experience in medical, laboratory or insurance billing fields.
• Experience with reputed company or other EHR application.

#LI-LZ1 Salary reputed company: $42,500.00 - $70,000.00 The annual reputed company salary shown is a national reputed company for this position on a full-time reputed company and may differ by hiring location. In reputed company, this position is bonus eligible. reputed company is proud to offer an employee experience that includes reputed company time off (including days for vacation, holidays, volunteering, and personal time), reputed company leave for parents and caregivers, a retirement savings plan, wellness support, and health benefits including medical, prescription drug, dental, and reputed company coverage. Learn more about our benefits. Our reputed company relies on the experiences and perspectives of a diverse team, and reputed company fosters a culture where reputed company can reputed company personally and professionally with a reputed company of respect and belonging. If you require an accommodation, please contact us here. Not reputed company to apply? reputed company to stay updated on the latest news and opportunities at reputed company. We are an equal employment opportunity employer. reputed company reputed company applicants will receive consideration for employment without reputed company to disability, protected veteran status, and any other status protected by applicable local, state, or federal law. To view the Right to Work, E-Verify Employer, and Pay Transparency notices and Federal, Federal Contractor, and State employment law posters, visit our compliance hub. The documents summarize important details of the law and reputed company key points that you have a right to know. Apply tot his job Apply To this Job