Prior Authorization Specialist

Prior Authorization Specialist — Remote Medical Office File prior authorizations, chase each one to a decision, and track visit counts and expiry dates so care isn't delivered without approval. An authorization that was never filed, or lapsed partway through a course of treatment, turns into a denial that is hard to overturn. In behavioral health especially, authorizations cover a set number of sessions for a set period, and someone has to watch both. As a prior authorization specialist you are that someone. What you will do Identify services that need prior authorization by payer and plan Submit authorization requests with the clinical documentation the payer asks for Follow up until each request is approved, pended or denied, and record the outcome Track authorized units, visits used and expiry dates, and request extensions in time Alert the practice before a patient runs out of authorized visits Coordinate peer-to-peer reviews and retro-authorization requests when allowed Attach authorization numbers to claims so they are not denied for missing auth What you need One or more years of prior authorization or referral coordination Experience with payer portals and fax-based authorization workflows Basic medical terminology and comfort reading clinical notes Persistence, organisation and clear communication with payers and providers Helpful, not required Behavioral health, psychiatry or imaging authorization experience, and knowledge of Medicaid managed care authorization rules. Working remotely at CredSpun Apply Prior Authorization Specialist 1 · About you First name * Last name * Email * Phone * City, State * LinkedIn profile Position * Years in medical billing / RCM * Earliest start date Certifications Systems you've worked in Resume * Upload your resume PDF or DOCX, up to 5 MB Resume * Upload your resume PDF or DOCX, up to 5 MB Why CredSpun? (optional) 3 · Resume & note Resume * Upload your resume PDF or DOCX, up to 5 MB Why CredSpun? (optional) Website I confirm the information above is accurate and agree to CredSpun storing my application for hiring purposes, as described in the privacy policy . #J-18808-Ljbffr CredSpun LLC