Prior Authorization Specialist
Listed on 2026-03-01
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Healthcare
Healthcare Administration, Medical Billing and Coding, Healthcare Management, Medical Office
Overview
Schedule:
Contingent, as needed. This role is remote.
Coordinates patient accounts from prior authorization to point of bill payment or referral to collection, including processing billing for home health agencies to appropriate agencies, including Medicaid and self-pay. Maintains current knowledge of changes in billing requirements and regulations and assists in resolving billing problems.
Job DescriptionEssential Functions:
- Verifies patient insurance coverage and eligibility for homecare services.
- Processes and submits insurance claims for reimbursement.
- Communicates with patients, insurance companies, and healthcare providers to resolve billing issues.
- Maintains accurate and up-to-date patient records and billing information.
- Monitors and tracks outstanding claims and follows up on unpaid or denied claims.
- Ensures compliance with all relevant regulations and guidelines related to homecare billing and reimbursement.
High School Diploma or equivalent, required.
Licensure Requirement(not specified)
Certifications(not specified)
Skills(not specified)
Experience- Two years of experience billing public and private insurers for medical services using computerized billing system, required.
- Homecare services experience, preferred.
OCCASIONALLY:
Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Standing, Walking
FREQUENTLY: (none specified)
CONTINUOUSLY:
Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing – Far/near, Sitting
Physical Requirements performed but not listed above
Talking on the phone / in person Frequently (34 - 66%)
The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision.
EOE M/F/Disability/Vet
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