Prior Authorization Specialist

Job Description

Location: Concord, NC

We are seeking an experienced and detail-oriented Prior Authorization Specialist to join our client’s healthcare team in Concord, NC. This work-from-home position is responsible for obtaining and processing prior authorizations for medical procedures, medications, and services. The ideal candidate will have a strong understanding of insurance processes, excellent communication skills, and the ability to work efficiently in a fast-paced healthcare environment.

Candidates must reside within a commutable distance to Concord, NC, to attend quarterly training sessions and team events.

Responsibilities:

• Review and process prior authorization requests for medications, procedures, and medical services.
• Ensure all required information and documentation are obtained to submit authorization requests to insurance companies.
• Communicate with healthcare providers, patients, and insurance companies to resolve any issues related to prior authorizations.
• Follow up on pending prior authorizations and ensure timely responses from insurance companies.
• Maintain accurate and up-to-date records of prior authorization requests, approvals, and denials.
• Collaborate with clinical staff to obtain necessary documentation and ensure compliance with payer requirements.
• Monitor changes in insurance policies and payer requirements to ensure the accuracy of submitted authorizations.
• Assist in troubleshooting and resolving issues related to prior authorizations, including denied claims and coverage discrepancies.
• Provide excellent customer service to patients, providers, and payers by responding promptly to inquiries and providing clear information about authorization status.
• Ensure compliance with HIPAA regulations and maintain confidentiality of patient information.

Qualifications:

• High school diploma or equivalent required; Associate degree in healthcare or a related field preferred.
• Minimum of 2 years of experience in prior authorization, medical billing, or a related healthcare field.
• Strong knowledge of insurance processes, prior authorization requirements, and payer regulations.
• Proficiency in medical terminology and understanding of healthcare procedures.
• Experience with electronic health records (EHR) and prior authorization software.
• Excellent organizational and time-management skills.
• Strong attention to detail and ability to work under pressure in a fast-paced environment.
• Excellent communication and interpersonal skills.
• Ability to handle sensitive patient information with discretion and confidentiality.

Salary Range: The salary range for this position is $35,000 –  $45,000 a year ($16.00 – $21.00 per hour), based on experience. 

Interview Process:

• Initial Screening Call with TalentLNX.
• Final Video Interview with the Operations Manager.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and prohibits discrimination and harassment of any kind. We are dedicated to building a diverse workforce and fostering an inclusive work environment where all employees and candidates are treated with respect and dignity. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other protected status under applicable law. We actively seek to recruit, develop, and retain talented individuals from diverse backgrounds, and we encourage all qualified candidates to apply for our job opportunities.