Quadris Team LLC
Healthcare Prior Authorizations Specialist -REMOTE
Quadris Team LLC, Oregon, Wisconsin, United States, 53575
Quadris Team, LLC - A Revenue Cycle Management Group, is searching for that dynamic person to join us, working with our highly skilled Authorizations Team to fill the role of
Prior Authorization Specialist . We are a 100%
remote team supporting our clients across the United States! See us at www.quadristeam.com.
The ideal applicant
will reside in Pacific Standard Time or Mountain Standard Time .
Job Focus Responsible for obtaining prior authorizations for facility services based on assigned specialty or clinic area. This position will secure the prior authorization and notify the rendering party in the timeliest manner possible so patients can receive necessary care and services with the least delay.
Responsible for answering patient calls, providing outgoing patient communication regarding financial obligations and authorization status. Responsible for patient estimation, benefit education, and payment processing.
Primary/Essential Expectations For Success
Accurately, efficiently and timely work prior authorization requests-referrals
Receive request for prior authorizations through the electronic health record (EHR) and/or via phone, email or fax and ensure that they are properly and closely tracked and monitored
Transcribe incoming referrals into electronic record (EHR) ensuring accurate patient data entry
Monitor incoming referral WQ's to verify insurance eligibility and referral requirements, facilitating timely patient scheduling
Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
Manage correspondence with insurance companies, physicians, specialists and patients as needed, including documenting in the EHR as appropriate
Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
Review accuracy and completeness of information requested and ensure that all supporting documents are present
Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial
Prioritize the incoming authorizations by level of urgency and date of service
Secure patient information in accordance with client policy/procedures
Other duties as assigned
Monitors WQs, and resolves accounts in a timely manner
Stay up to date on insurance company policies and procedures related to prior authorizations
Physical/Mental Demands, Environment
Prolonged periods of sitting at a desk and working on a computer
Must be able to lift 15 pounds at one time
Must be able to structure your home office to ensure patient information is secure meeting the regulatory expectations
Skills Needed to Be Successful
Maintains compliance with regulations and laws applicable to job
Professional level of communication with video, phone, and email
Ability to effectively prioritize the work to meet deadlines and expectations
Meets the quality and productivity measures as outlined by Quadris
Brings positive energy to work
Uses critical thinking skills
Being present and focused on assigned tasks and eliminates distractions
Being a self-starter
Ability to work independently and within a team atmosphere
Core Talent Essentials
High School diploma or equivalent
1+ years of experience working in health care, medical billing, with a focus on prior authorization preferred
PACS (Prior Authorization Certified Specialist) Certification preferred
Knowledge of insurance process and medical terminology preferred
Honors and sets high expectations for patient confidentiality and customer service in accordance with Quadris Team policies and procedures and HIPAA requirements
Advanced level of industry standard electronic medical record content
Must have professional level skills in MS products such as Excel, Word, Power Point.
Proficient application of business/office standard processes and technical applications
Quadris is an Equal Employment Opportunity employer. Any offer of employment is contingent upon a criminal background check, previous employment verification and references, following all federal and state regulations. Quadris Team is a participant of eVerify.
#J-18808-Ljbffr
Prior Authorization Specialist . We are a 100%
remote team supporting our clients across the United States! See us at www.quadristeam.com.
The ideal applicant
will reside in Pacific Standard Time or Mountain Standard Time .
Job Focus Responsible for obtaining prior authorizations for facility services based on assigned specialty or clinic area. This position will secure the prior authorization and notify the rendering party in the timeliest manner possible so patients can receive necessary care and services with the least delay.
Responsible for answering patient calls, providing outgoing patient communication regarding financial obligations and authorization status. Responsible for patient estimation, benefit education, and payment processing.
Primary/Essential Expectations For Success
Accurately, efficiently and timely work prior authorization requests-referrals
Receive request for prior authorizations through the electronic health record (EHR) and/or via phone, email or fax and ensure that they are properly and closely tracked and monitored
Transcribe incoming referrals into electronic record (EHR) ensuring accurate patient data entry
Monitor incoming referral WQ's to verify insurance eligibility and referral requirements, facilitating timely patient scheduling
Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
Manage correspondence with insurance companies, physicians, specialists and patients as needed, including documenting in the EHR as appropriate
Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
Review accuracy and completeness of information requested and ensure that all supporting documents are present
Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial
Prioritize the incoming authorizations by level of urgency and date of service
Secure patient information in accordance with client policy/procedures
Other duties as assigned
Monitors WQs, and resolves accounts in a timely manner
Stay up to date on insurance company policies and procedures related to prior authorizations
Physical/Mental Demands, Environment
Prolonged periods of sitting at a desk and working on a computer
Must be able to lift 15 pounds at one time
Must be able to structure your home office to ensure patient information is secure meeting the regulatory expectations
Skills Needed to Be Successful
Maintains compliance with regulations and laws applicable to job
Professional level of communication with video, phone, and email
Ability to effectively prioritize the work to meet deadlines and expectations
Meets the quality and productivity measures as outlined by Quadris
Brings positive energy to work
Uses critical thinking skills
Being present and focused on assigned tasks and eliminates distractions
Being a self-starter
Ability to work independently and within a team atmosphere
Core Talent Essentials
High School diploma or equivalent
1+ years of experience working in health care, medical billing, with a focus on prior authorization preferred
PACS (Prior Authorization Certified Specialist) Certification preferred
Knowledge of insurance process and medical terminology preferred
Honors and sets high expectations for patient confidentiality and customer service in accordance with Quadris Team policies and procedures and HIPAA requirements
Advanced level of industry standard electronic medical record content
Must have professional level skills in MS products such as Excel, Word, Power Point.
Proficient application of business/office standard processes and technical applications
Quadris is an Equal Employment Opportunity employer. Any offer of employment is contingent upon a criminal background check, previous employment verification and references, following all federal and state regulations. Quadris Team is a participant of eVerify.
#J-18808-Ljbffr