Eligibility and Prior Authorization Specialist-Temp to hire -USA-ID-7954

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Position Summary:
The Eligibility and Prior Authorization Specialist is responsible for building and maintaining collaborative relationships with internal and external stakeholders to support eligibility verification and prior authorization processes. This role involves managing revenue cycle projects, driving operational performance related to reimbursement, and overseeing processes impacting cash collections.
Primary Responsibilities:

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  • Conduct thorough prior authorization case reviews and follow-ups, ensuring all attempts are exhausted before escalating to vendors and/or internal teams.
  • Accurately document all authorization activities, follow-ups, and outcomes in the designated systems and trackers.
  • Address denied or delayed authorizations by investigating issues, providing necessary documentation, and submitting appeals as required.
  • Exercise critical thinking to evaluate case statuses, identify escalation triggers, and route unresolved issues to appropriate teams or vendors.
  • Serve as a source of knowledge for the designated revenue cycle function.
  • Perform analysis, identify trends, and prioritize initiatives for performance improvement in the designated revenue cycle area.
  • Establish ongoing working relationships with other departments that impact revenue cycle performance.
  • Work closely with various vendor operations teams (Prior Authorization, Claims, and Appeals) to oversee operations activity and ensure timely and accurate processing for optimal reimbursement.
  • Track outcomes of payment resolutions, appeals, and negotiated claims to ensure goals are met.
  • Monitor eligibility and prior authorization changes, research, evaluate, and interpret guidance from various sources to determine departmental actions.
  • Coordinate with management to address trends and issues affecting revenue cycle performance.

Required Knowledge, Skills, and Abilities:

  • Proficiency in medical billing systems, payer portals, and Microsoft Excel.
  • Strong knowledge of medical terminology, abbreviations, and coding standards (CPT/HCPCS, ICD-10, modifiers, UB revenue codes).
  • Ability to work independently and collaboratively to manage multiple tasks in a fast-paced environment.
  • Critical thinking skills to identify trends, articulate findings, and implement solutions that impact the revenue cycle.
  • Strong communication (verbal and written), organizational, and problem-solving skills.
  • Analytical skills to assess data and navigate competing priorities effectively.
  • Maintain confidentiality of sensitive information.

Qualifications:

  • At least 3 years of experience in medical billing and insurance collections.
  • At least 3 years of experience with eligibility and prior authorization requirements, payer utilization management policies, and appeals.
  • At least an Associate’s Degree preferred; Bachelor’s Degree in a healthcare-related field or equivalent experience is highly desirable.

Pay Range:
The pay range for this role is $23–$28/hr. Actual compensation packages are based on a variety of factors, including skills, experience, certifications, and specific office location.

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