What are the responsibilities and job description for the Prior Authorization Specialist position at TEKsystems?
*Description*
Medical Device Manufacturer is expanding their services to support Penial Implant surgeries. This group will take on the extra work to support their customers getting coverage for their surgery. This program was created just a year ago and they're experiencing more than double the volume and expecting more.
This program verifies benefits and works on prior authorization. Working directly with physician offices regarding coverage for surgery. This isn't always an easy surgery to get covered.
Job responsibilities for the Reimbursement Specialist
*Act as an advocate for our customers as it relates to coverage.
*Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for customers.
*Obtain authorization, or pre-certifications required for patients to access coverage for Interventional Urology products.
*Knowledge of commercial payers, Medicare and Medicaid and their benefit structure(s)
*Requests medical documentation from providers not limited to nurse case reviewers and clinical staff to build on claims for medical necessity.
*Educates customers, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
*Verifies that all products that require prior authorizations are complete. Updates customers and customer support team on status. Assists in coordinating appeals if required by insurance payer.
*Maintains knowledge of the following: Medicare, Medicaid and Commercial payer requirements, guidelines, and policies.
*Ability to communicate reimbursement and access topics concisely and clearly to office staff and/or patients
*Work with customers if an exception to coverage is needed.
*Answer incoming calls from customers / patients and about the insurance verification process using appropriate customer service skills and in a professional, knowledgeable, and courteous manner.
*Runs details reports and analyzes coverage data and trends
*Travel 10-20% of the time
*Other duties as assigned by the management team.
*Skills*
Prior authorization, Customer service, Support, claims processing, insurance, benefits verification, appeals
*Top Skills Details*
Prior authorization, Customer service, Support
*Additional Skills & Qualifications*
HS Diploma
7 years of experience working in a medical office
BS Degree and 3 years of experience working in a medical office
*Experience Level*
Expert Level
*Pay and Benefits*
The pay range for this position is $25.00 - $30.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
* Medical, dental & vision
* Critical Illness, Accident, and Hospital
* 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
* Life Insurance (Voluntary Life & AD&D for the employee and dependents)
* Short and long-term disability
* Health Spending Account (HSA)
* Transportation benefits
* Employee Assistance Program
* Time Off/Leave (PTO, Vacation or Sick Leave)
*Workplace Type*
This is a fully remote position.
*Application Deadline*
This position is anticipated to close on Apr 7, 2025.
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Medical Device Manufacturer is expanding their services to support Penial Implant surgeries. This group will take on the extra work to support their customers getting coverage for their surgery. This program was created just a year ago and they're experiencing more than double the volume and expecting more.
This program verifies benefits and works on prior authorization. Working directly with physician offices regarding coverage for surgery. This isn't always an easy surgery to get covered.
Job responsibilities for the Reimbursement Specialist
*Act as an advocate for our customers as it relates to coverage.
*Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for customers.
*Obtain authorization, or pre-certifications required for patients to access coverage for Interventional Urology products.
*Knowledge of commercial payers, Medicare and Medicaid and their benefit structure(s)
*Requests medical documentation from providers not limited to nurse case reviewers and clinical staff to build on claims for medical necessity.
*Educates customers, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
*Verifies that all products that require prior authorizations are complete. Updates customers and customer support team on status. Assists in coordinating appeals if required by insurance payer.
*Maintains knowledge of the following: Medicare, Medicaid and Commercial payer requirements, guidelines, and policies.
*Ability to communicate reimbursement and access topics concisely and clearly to office staff and/or patients
*Work with customers if an exception to coverage is needed.
*Answer incoming calls from customers / patients and about the insurance verification process using appropriate customer service skills and in a professional, knowledgeable, and courteous manner.
*Runs details reports and analyzes coverage data and trends
*Travel 10-20% of the time
*Other duties as assigned by the management team.
*Skills*
Prior authorization, Customer service, Support, claims processing, insurance, benefits verification, appeals
*Top Skills Details*
Prior authorization, Customer service, Support
*Additional Skills & Qualifications*
HS Diploma
7 years of experience working in a medical office
BS Degree and 3 years of experience working in a medical office
*Experience Level*
Expert Level
*Pay and Benefits*
The pay range for this position is $25.00 - $30.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
* Medical, dental & vision
* Critical Illness, Accident, and Hospital
* 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
* Life Insurance (Voluntary Life & AD&D for the employee and dependents)
* Short and long-term disability
* Health Spending Account (HSA)
* Transportation benefits
* Employee Assistance Program
* Time Off/Leave (PTO, Vacation or Sick Leave)
*Workplace Type*
This is a fully remote position.
*Application Deadline*
This position is anticipated to close on Apr 7, 2025.
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Salary : $25 - $30
