Job Description
Title: Clinic Authorization Specialist
Location: United States – Remote
Description
We are looking for a detail-oriented Authorization Specialist to handle daily authorization requests for in-network clinics. The position entails answering a high volume of phone calls and emails. The successful candidate will be able to ensure an elevated level of customer service, maintain positive relationships within the network and maximize productivity by reviewing accuracy for data processing. The Authorization Specialist must be able to operate in a fast-paced environment, manage difficult conversations, be thoughtful, resourceful, collaborative, and customer focused.
Whatyou’lldo
- Manage a high volume of provider calls and emails time management and efficiency are critical!
- Be passionate about providing the best possible provider and member experience at all times
- Review and analyze complex fertility related authorization requests by navigating multiple systems and platforms and accurately capture the data/information for processing (e.g. verify prior authorizations, applicable benefits)
- Communicate with providers regarding authorizations or required additional information for accurate authorizations
- Interpret and enforce clinic contracts as it relates to covered services and authorizations; be a fearless and persuasive speaker in encouraging partner providers to maintain compliance with best practices and contractual guidelines; be able to overcome objections and ensure authorizations align with contractual guidelines
- Be flexibleand to adapt with evolving business needs
About you
- Prior experience required in a health care environmentknowledge of the fertility industry is preferred
- Undergraduate degree
- Prior experience using Microsoft excel and outlook, and Salesforce knowledge preferred
- Ability to manage multiple priorities including understanding various insurance products and levels of benefit within each product.
- Comfortable in an environment with data-driven goals with monthly performance feedback
- Flexible and able to navigate change
- Ability to manage difficult conversations
- Knowledge of CPT, HCPCS, AND ICD-10 codes and understanding of medical terminology strongly preferred
- Ability to work independently and demonstrate good judgment
- Excellent interpersonal skills – ability to communicate accurately and effectively with internal and external stakeholders
- Highly organized, quick learner, with ability to multitask and prioritize work effectively