Cynet Systems
Job Description:
Pay Range: $21.83hr - $26.83hr
The Pre-Authorization Specialist II is responsible for verifying insurance benefits, submitting prior authorization requests, following up with payers, and supporting patients and healthcare providers throughout the authorization process. This role ensures accurate documentation, superior customer service, and compliance with regulations while working in a high-volume environment. Responsibilities:
Verify medical insurance benefits and coverage, including obtaining and processing payer forms. Submit prior authorization and pre-determination requests, as well as internal and external appeals to health plans. pply pressure on health plans that refuse review based on negative or absent coverage policies for Endobariatric procedures. Follow up on prior authorization and appeal requests to ensure receipt and proper medical necessity review. Monitor and engage payers until final determination is made, exhausting all appeal levels when necessary. nswer incoming calls from the toll-free PASP call center and provide superior customer service. Document case statuses, actions, and outcomes using Microsoft Office and Salesforce. Communicate effectively with healthcare provider offices and internal stakeholders. Maintain PASP metrics and standards. Process incoming emails and triage inquiries appropriately. Process incoming faxes to manage service requests and facilitate communication. Report adverse events and product complaints according to SOPs. Comply with SOPs to maintain data integrity. Maintain HIPAA compliance and protect patient confidentiality. Support continuous improvement and uphold organizational values. Deliver superior service in a high-volume environment. Coordinate with leads regarding complex cases. Perform other duties as assigned. Requirement/Must Have:
High school diploma. Minimum 2 years of relevant experience, including: Working with various payers such as Medicare, Medicaid, private/commercial plans, and VA. Reviewing clinical records and extracting key information to support medical necessity. Submitting prior authorization requests for medical procedures. Understanding and using payer coverage criteria to ensure positive outcomes. Proficiency in Microsoft Office. Excellent written and verbal communication skills. bility to work independently with minimal to moderate supervision.
Should Have:
ssociate's degree. Experience in medical devices or bariatrics. Experience using systems such as Salesforce, EMR, payer portals, or Policy Reporter. Experience interpreting medical necessity and experimental/investigational denials and drafting appeals. Skills:
Insurance verification. Prior authorization processing. ppeals preparation. Stakeholder communication. Case documentation and tracking. High-volume workflow management. Qualification And Education:
High school diploma required. ssociate's degree preferred.
Pay Range: $21.83hr - $26.83hr
The Pre-Authorization Specialist II is responsible for verifying insurance benefits, submitting prior authorization requests, following up with payers, and supporting patients and healthcare providers throughout the authorization process. This role ensures accurate documentation, superior customer service, and compliance with regulations while working in a high-volume environment. Responsibilities:
Verify medical insurance benefits and coverage, including obtaining and processing payer forms. Submit prior authorization and pre-determination requests, as well as internal and external appeals to health plans. pply pressure on health plans that refuse review based on negative or absent coverage policies for Endobariatric procedures. Follow up on prior authorization and appeal requests to ensure receipt and proper medical necessity review. Monitor and engage payers until final determination is made, exhausting all appeal levels when necessary. nswer incoming calls from the toll-free PASP call center and provide superior customer service. Document case statuses, actions, and outcomes using Microsoft Office and Salesforce. Communicate effectively with healthcare provider offices and internal stakeholders. Maintain PASP metrics and standards. Process incoming emails and triage inquiries appropriately. Process incoming faxes to manage service requests and facilitate communication. Report adverse events and product complaints according to SOPs. Comply with SOPs to maintain data integrity. Maintain HIPAA compliance and protect patient confidentiality. Support continuous improvement and uphold organizational values. Deliver superior service in a high-volume environment. Coordinate with leads regarding complex cases. Perform other duties as assigned. Requirement/Must Have:
High school diploma. Minimum 2 years of relevant experience, including: Working with various payers such as Medicare, Medicaid, private/commercial plans, and VA. Reviewing clinical records and extracting key information to support medical necessity. Submitting prior authorization requests for medical procedures. Understanding and using payer coverage criteria to ensure positive outcomes. Proficiency in Microsoft Office. Excellent written and verbal communication skills. bility to work independently with minimal to moderate supervision.
Should Have:
ssociate's degree. Experience in medical devices or bariatrics. Experience using systems such as Salesforce, EMR, payer portals, or Policy Reporter. Experience interpreting medical necessity and experimental/investigational denials and drafting appeals. Skills:
Insurance verification. Prior authorization processing. ppeals preparation. Stakeholder communication. Case documentation and tracking. High-volume workflow management. Qualification And Education:
High school diploma required. ssociate's degree preferred.