Prior Authorization Assistant (Healthcare)

This is a remote position.

• 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.

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

• Permanent work from home
• Immediate hiring