What are the responsibilities and job description for the Prior Authorization Specialist position at eBlu Solutions LLC?
Description
Are you looking for an opportunity to help providers ensure prior authorization is completed accurately and promptly? Then this is the role for you! eBlu' Solutions Prior Authorization Specialist role is a key role that provides a service to practices throughout the United States to initiate and monitor Prior Authorization to completion. We are looking for patient individuals who can pivot when needed, have attention to detail, and possess positive attributes.
JOB SUMMARY
The Prior Authorization Specialist is responsible for tracking the client’s prior authorization status through completion. This role will accurately process the requests according to regulatory and client-specific guidelines.
KEY RESPONSIBILITIES
- Submit prior authorization forms to the payer
- Contact payers to verify authorization status
- Track and manage the authorization process
- Maintain and update payer prior authorization forms
- Respond to and resolve all internal and external inquiries in a timely, accurate, and complete manner.
- Process authorizations based on department guidelines and in accordance with standards and performance indicators
- Maintain all patient confidentiality
- Manage prior authorization activity queue
- Provides timely communication throughout the prior authorization process
- Conducts appropriate follow-up on a daily basis, on all pending authorizations until a final determination has been made
- Conduct complete medical and pharmacy Benefit Investigations as needed
- Other duties and responsibilities as assigned by the supervisor based on the specific client contract.
Requirements
EDUCATION
- High School Diploma or GED required
- Bachelor's degree preferred or equivalent work experience
EXPERIENCE
- 3-5 years experience in a health plan, facility, healthcare provider office, or pharmaceutical industry required
- Experience working with insurance companies and extensive knowledge of different types of coverage and policies required
- Experience with pre-certification or pre-authorization required
- 3-5 years experience in a call center preferred
- Knowledge of medical terminology preferred
- Working knowledge of drug reimbursement issues preferred
- Understanding of health plan medical policies and prior authorization criteria
- Knowledge of HCPCS, CPT, and ICD-10 coding
SKILLS
- Must have excellent multitasking skills to allow for success in the role
- Have exceptional attention to detail and excellent analytical, investigation, and problem-solving skills
- Must be very detail-oriented and organized to maintain accurate patient insurance records
- Ability to focus and work quickly within a 24-hour turnaround for patient insurance information.
- Strong communication and interpersonal skills.
- Ability to work and resolve issues independently and collaboratively in a team environment.
- Proactive and able to take initiative in driving projects forward.
- Ability to follow instructions
- Strong computer skills; preferably Microsoft Word or Excel software applications
- Ability to calculate figures and amounts such as discounts and percentages; necessary to provide correct benefit and co-pay information
- Ability to manage multiple priorities concurrently
PHYSICAL & TECHNICAL ENVIRONMENT
- Ability to work at a desk in the office for long periods of time.
- The noise level in the work environment is moderate.
- Specific vision abilities required by this job include close vision and color vision.
- Ability to maintain focus under high levels of pressure/multiple priorities.
BENEFITS
- Competitive pay and performance-based incentives
- Comprehensive health, dental, and vision insurance
- Retirement savings plan with company matching.
- Flexible schedules with both remote and hybrid work options.
- Professional development and growth opportunities
- Generous paid time off and holiday schedule
EBLU SOLUTIONS IS AN EQUAL-OPPORTUNITY EMPLOYER
eBlu Solutions seeks talent from all backgrounds to bring diversity of thought, agility, and capability to our organization. We promote a working environment where all employees are treated and rewarded fairly. We do not tolerate any form of discrimination that adversely affects individuals or groups based on national origin, race, color, religion, sex, gender, sexual orientation, marital status, disability, age, or any other legally protected aspect of a person’s identity.
ABOUT EBLU SOLUTIONS
eBlu Solutions was founded in 2012 to help specialty medical practices manage the complex workflow associated with high-cost infusion and injection treatments. A single denied claim can be costly to the provider and the patient. Because of this risk, provider offices are willing to put up with long hold times to talk to insurance company provider services and multiple pharmaceutical manufacturer portals. We believe there’s a better way. That's why eBlu Solutions has developed a single portal for managing all the data behind your in-office infusion and injection therapies. We help you mitigate risk, improve staff efficiency, and reduce your training and onboarding burden for new staff members. We are eBlu Solutions, and we are here to make your life easier.