What are the responsibilities and job description for the Prior Authorization Team Member position at Eventus WholeHealth ?
Key Responsibilities: Process Oversight: Ensure timely and accurate processing of prior authorization requests. Develop and implement process improvements to enhance efficiency and accuracy. Monitor workflow and adjust as needed to meet departmental goals and deadlines. Ensure compliance with all applicable policies, procedures, and regulatory requirements. Collaboration and Communication: Coordinate with healthcare providers, insurance companies, and other stakeholders to resolve issues and facilitate approvals. Communicate effectively with team members, management, and external partners. Data Management and Reporting: Maintain accurate records of prior authorization requests and outcomes. Utilize data to identify trends and areas for improvement. Quality Assurance: Conduct regular audits of prior authorization requests to ensure accuracy and compliance. Implement quality control measures to minimize errors and improve service delivery. Address and resolve any identified issues promptly. Qualifications High School diploma
Three years of experience in a prior authorization role is preferred.
Skills and Abilities: Strong understanding of prior authorization processes and healthcare regulations. Strong analytical and problem-solving abilities. Exceptional communication and interpersonal skills. Proficiency in healthcare management software and systems. Ability to work in a fast-paced, dynamic environment. Working Conditions: This position may require occasional evening or weekend hours to meet departmental needs. The role is primarily remote, with some potential for office and field work depending on organizational policies and team meetings. Physical Demands: Must be able to travel to locations. Routine use of standard office equipment such as computers and phones. Ability to lift up to 25 pounds. Standing, walking, bending, kneeling, and stooping as required. Benefits Career growth potential. Work/life balance focused company. PTO annually for qualifying full-time employees. Medical, Dental, Vision, and Life Insurance. 401K (available for part-time and full-time employees). Short-term and long-term disability insurance. Competitive pay with annual performance reviews and merit-based raises. Reimbursement available for continued education and conferences
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