JOULESTOWATTS BUSINESS SOLUTIONS PRIVATE LIMITED
Prior Authorization Specialist
JOULESTOWATTS BUSINESS SOLUTIONS PRIVATE LIMITED, Remote, Oregon, United States,
Location: *Fully remote role with preferred work hours 8am-5pm CT.*
Do you have the following skills, experience and drive to succeed in this role Find out below.
*Skills required:** 7-10 years of specific experience* Must have experience in Oncology, a Laboratory or internal medicine clinic.* Hospital experience is fine as well.* Experience as a Medical Assistant is a big plus!* Processing prior authorizations* Bilingual – Spanish/English (must be able to read medical terminology in Spanish)
*Summary Description:*
Under general direction, this position is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications and could include scheduling appointments for outpatient testing with other providers, coordinates patient appointments/orders.
*Daily Responsibilities:** Obtain timely prior authorization/ prior- determination/ or pre – certification from all insurances, that require based upon plan or insurance contract, following the company established policies and protocols.* Selecting accurate medical records for patients and obtaining and validating demographic and insurance information.* Provide all required medical information to insurance companies as necessary to facilitate the authorization process.* Follow up promptly on insurance determinations regarding submitted requests.* Run system generated reports to verify procedures by insurances requiring authorization are being captured.* Must request, obtain, and document (within current software) all prior authorizations (or denials of same) appropriately and in a timely manner.* Maintain and update internal listing of insurance carriers that require authorization and their processes.* Obtain retro authorizations as needed.* Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements.
*Skills and Education: ** High School Diploma or GED required.* Knowledge of Medical Terminology and ability to interpret clinical documentation.* Good understanding of ICD10, CPT codes, can HCPCS codes.* Good understanding of third-party reimbursement procedures for all types of insurance plans, including governmental, commercial and Workers Compensation.* Computer literacy and proficiency in using Microsoft Office* At least 2 years of experience in a doctor’s office as a medical assistant.* At least 1+ years of experience in getting prior authorizations for the Specialists, preferably with Orthopedics, Cardiology, Imaging procedures.
*Company Benefits and Perks:*
Joining us comes with an array of benefits, flexible work hours when possible, and a genuine sense of belonging to a dynamic and growing organization.* Access to a 401(k) Retirement Savings Plan.* Comprehensive Medical, Dental, and Vision Coverage.* Paid Time Off.* Paid Holidays.* Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.
If you are a dedicated and experienced PA Specialist ready to contribute to our mission and be part of our diverse and inclusive community, we invite you to apply and join our team.
Job Type: Full-time
Pay: $16.00 - $20.00 per hour
Benefits:* 401(k) matching* Dental insurance* Employee assistance program* Employee discount* Health insurance* Paid time off* Retirement plan* Vision insurance
Experience:* Orthopedics, Cardiology, Imaging procedures: 1 year (Required)* doctor’s office as a medical assistant: 2 years (Required)* Processing prior authorizations: 3 years (Required)
Language:* Bilingual – Spanish / English (Preferred)
Work Location: RemoteRemote working/work at home options are available for this role.
Do you have the following skills, experience and drive to succeed in this role Find out below.
*Skills required:** 7-10 years of specific experience* Must have experience in Oncology, a Laboratory or internal medicine clinic.* Hospital experience is fine as well.* Experience as a Medical Assistant is a big plus!* Processing prior authorizations* Bilingual – Spanish/English (must be able to read medical terminology in Spanish)
*Summary Description:*
Under general direction, this position is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications and could include scheduling appointments for outpatient testing with other providers, coordinates patient appointments/orders.
*Daily Responsibilities:** Obtain timely prior authorization/ prior- determination/ or pre – certification from all insurances, that require based upon plan or insurance contract, following the company established policies and protocols.* Selecting accurate medical records for patients and obtaining and validating demographic and insurance information.* Provide all required medical information to insurance companies as necessary to facilitate the authorization process.* Follow up promptly on insurance determinations regarding submitted requests.* Run system generated reports to verify procedures by insurances requiring authorization are being captured.* Must request, obtain, and document (within current software) all prior authorizations (or denials of same) appropriately and in a timely manner.* Maintain and update internal listing of insurance carriers that require authorization and their processes.* Obtain retro authorizations as needed.* Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements.
*Skills and Education: ** High School Diploma or GED required.* Knowledge of Medical Terminology and ability to interpret clinical documentation.* Good understanding of ICD10, CPT codes, can HCPCS codes.* Good understanding of third-party reimbursement procedures for all types of insurance plans, including governmental, commercial and Workers Compensation.* Computer literacy and proficiency in using Microsoft Office* At least 2 years of experience in a doctor’s office as a medical assistant.* At least 1+ years of experience in getting prior authorizations for the Specialists, preferably with Orthopedics, Cardiology, Imaging procedures.
*Company Benefits and Perks:*
Joining us comes with an array of benefits, flexible work hours when possible, and a genuine sense of belonging to a dynamic and growing organization.* Access to a 401(k) Retirement Savings Plan.* Comprehensive Medical, Dental, and Vision Coverage.* Paid Time Off.* Paid Holidays.* Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.
If you are a dedicated and experienced PA Specialist ready to contribute to our mission and be part of our diverse and inclusive community, we invite you to apply and join our team.
Job Type: Full-time
Pay: $16.00 - $20.00 per hour
Benefits:* 401(k) matching* Dental insurance* Employee assistance program* Employee discount* Health insurance* Paid time off* Retirement plan* Vision insurance
Experience:* Orthopedics, Cardiology, Imaging procedures: 1 year (Required)* doctor’s office as a medical assistant: 2 years (Required)* Processing prior authorizations: 3 years (Required)
Language:* Bilingual – Spanish / English (Preferred)
Work Location: RemoteRemote working/work at home options are available for this role.