Prior Authorization Specialist

PRIA Healthcare Management, LLC offers a rewarding environment for hardworking, self-motivated individuals. Headquartered in the United States, we are a full-spectrum reimbursement services organization that partners with clients from early ideation through commercialization. Our team’s mission is to accelerate the adoption of healthcare innovation by advocating for consistent and reliable reimbursement. PRIA is comprised of experts from reimbursement/ market access, industry, business, and finance.

We are currently looking for a remote Prior Authorization Specialist that is ready to join our team of skilled and dedicated individuals supporting the mission of patient access to care and customer service. 

Experience working with insurance appeals and the prior authorization process is preferred. Knowledge of medical reimbursement policies within a healthcare organization is preferred. Previous Medical Billing experience and/or Certified Coding Specialists are a plus. Problem-solving skills are also crucial in this role.

Job Responsibilities

• Data-enter new patient cases into system database
• Gather supporting documentation from physician offices and facilities (i.e. patient medical records, consent forms, insurance correspondence) to support authorization or appeal request
• Submission of prior authorizations and appeals with commercial insurance
• Submission of post-service claim appeals with commercial insurance and Medicare
• Complete eligibility and verification of benefits
• Draft letters to support authorizations and appeals specific to each patient
• Follow up with payers over the phone to get status of cases/decisions
• Communicate with physician’s office and their staff regularly
• Provides exceptional customer service to patients and providers
• Comply with HIPAA laws and company policies and procedures

Required Skills

• Experience working with insurance claims, appeals, prior authorizations and is preferred

• Experience with Medicare, Medicaid, Tricare, Workers Compensation and Commercial Insurance

• Attention to detail and deadlines

• Expertise in CRM software or databases is a plus

• Ability to work independently with strong interpersonal skills to effectively interact with all levels of employees

• Must be proficient in Microsoft Office

• Must demonstrate excellent communication skills, verbal and written

Benefits

• Competitive compensation package

• Generous Paid Time Off

• Comprehensive Medical/Dental/Vision plan

• 401K with 3% match

• Tuition Reimbursement Program

• Generous Employee Referral Program

• Rewards & Recognition Platform

• Professional development opportunities

• Employee health & wellness programs