Prior Authorization Specialist

Job Description

DAY TO DAY:

This individual will be responsible for:

• Processing HMO authorizations

• Managing HMO referrals

• Supporting medical imaging authorizations

• Supporting infusion authorizations

• Working daily Epic work queues

• Managing and responding to daily email assignments

• Communicating with payers, internal clinical teams, and scheduling partners to ensure timely financial clearance

• Some inbound patient calls, but 90% of communication will be through portals

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy:

Skills and Requirements

MUST HAVES:

• High school diploma

• Prior authorization verification experience

• For Medical imaging and infusion

• Prior insurance experience

• Demonstrates knowledge of utilization management process

• Hands-on experience with insurance portals, including:

• Availity, Carelon, Telligent (HMO referrals and authorizations)

• Medicaid experience

• Clinical knowledge and understanding of medical services

• Epic experience

• At least two years of experience in pre-certification initiation in a healthcare/ health office setting

• Tech Savvy - Proficient in Microsoft Office (Teams specifically) BS or BSA preferred