Specialist Billing

The Position:

The successful candidate will be a rockstar in the health plan prior authorization management and processing. While working with our Reimbursement, Commercial, and Finance teams this role will provide on-going insight and analytics of the medical billing and reimbursement cycle. 

This is a remote position that requires collaboration with teams in Central time zone. The expected hours of this position ideally would be 7am – 4pm Central. We are also open to candidates in other time zones.  

Responsibilities include:

• Processing of prior authorization cases via Glidian, eviCore and direct health plan portals
• Knowledge in insurance payor authorization guidelines, and follow-up of authorization status from health plan.
• Researching and responding to heavy authorization caseload in a timely manner.
• Reviewing and provide an analysis of prior authorization determination denials and approvals.
• Organize and maintain comprehensive files that include health plan prior authorization turnaround time, appeal guidelines and other pertinent information.
• Review medical records and respond to health plan clinical questions.
• Researching and monitoring of health plan issues, trends and potential risks and provide feedback to managers.
• Providing administrative support (when requested) including performing data entry, updating various record keeping systems, upholding company policies and Client requirements, and participating in projects, duties, and other administrative tasks.
• Knowledge, understanding, and compliance with all applicable Federal and Local laws and regulations relating to job duties.
• Knowledge, understanding, and compliance with Company policies and procedures.
• Other duties as assigned.

Who You Are:

• 3-5 Years of direct appeals and billing experience
• Enthusiasm and an entrepreneurial spirit
• Familiarity with ICD and HCPC/CPT coding preferred
• Familiarity with CMS 1500 claim form preferred
• Familiarity with Claim Adjustment Reason Codes (NUCC) preferred
• Use of personal computer, computer applications, and general office equipment including scanners.
• Ability to create and maintain spreadsheets
• Ability to use analytical, interpersonal, communication, organizational, numerical, and time management skills.
• Experience handling and expediting escalated issues, with follow up to the customer.
• Ability to quickly assess a situation and take appropriate actions to address customer needs and requests in a timely and efficient manner. Self-starter with the ability to work independently and effectively in a team environment.
• Ability to organize and prioritize multiple projects/tasks and meet deadlines in a constantly evolving and fast-paced environment.
• Strong, consistent work ethic with a keen attention to details and ability to focus on the big picture.
• Excellent written and verbal communication skills.
• Must be able to communicate with confidence and tact across all levels within the company.

#LI-Remote