Prior Authorization Specialist

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a dedicated Prior Authorization Specialist responsible for obtaining prior authorizations and precertifications for various medical services such as radiology exams, oncology services, procedures, and chemotherapy drugs. This position will involve reviewing insurance requirements, liaising with insurance payers, and ensuring that all processes adhere to medical guidelines and regulations.

Key Responsibilities

• Obtain prior authorizations/precertifications for radiology exams, radiation oncology services, and chemotherapy drugs.
• Review insurance requirements and payer-specific authorization processes.
• Analyze clinical information in the EMR to determine requested services.
• Contact insurers via various means to submit and follow up on authorization requests.
• Utilize national medical guideline tools to support authorization requests.
• Verify and document all insurance requirements before approvals.
• Navigate established workflows for pending authorization cases.
• Communicate with providers and clinical staff regarding authorization issues.
• Act as the primary contact for outside facility requests involving clients.
• Respond to client emails and calls within set policy timeframes.
• Accurately document authorization correspondence in PM and EMR systems.
• Adhere to policies regarding treatment therapies and substitutions.
• Maintain confidentiality, professionalism, quality, and service standards.
• Comply with HIPAA requirements.
• Perform additional duties as assigned.

Qualifications

• 2-3+ years of prior authorization experience.
• Experience in Radiation Oncology (RadOnc).
• Understanding of Radiation Oncology treatment workflows and terminology.
• Knowledge of insurance requirements and payer authorization processes.
• Proficiency in operating standard office equipment and computer systems.

Experience

• 2-3+ years in prior authorization

Skills

• Technical skills: Proficiency with EMR and PM systems
• Soft skills: Excellent communication, ability to collaborate with healthcare professionals

Additional Requirements

• Contract to HIRE opportunity

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).


Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

* As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.