Prior Authorization Representative

Emerge Pediatric Therapy is looking for a local Remote Full Time Prior Authorization Representative to add to their growing team! This person would act as a secondary Authorization Representative across our three clinics, while also providing additional task support to the billing team.

Responsibilities
The Prior Authorization Representative's purpose is to manage all submissions for authorization of therapy services. This includes timeline management, submission oversight and follow up and detailed record keeping to ensure that clients do not have gaps in benefit coverage. This may be accomplished in the following ways:

Verifying eligibility of patients insurance
Submitting initial and concurrent authorizations to Medicaid, Medicaids Managed Care Organizations (MCOs), Medicaid's Tailored HealthPlans, Tricare and/or any commercial insurance payer as required.
Completing necessary documentation and submissions for clients to obtain out-of-network coverage agreements
Any other tasks delegated by the Billing Manager after provided with the proper training: Monthly insurance eligibility verification checks, medical documentation requests, etc.
Making outbound calls to insurance companies, patients and physician offices as needed
Coordinates and follows up with clinical and office staff to ensure completion of required documentation.
Accurately inputs prior authorizations and maintains client files in company EHR system
Submitting additional medical record requests for claims, appeals or pre/post payment reviews.

Skills and Qualifications

Knowledge of NC Medicaid, NC Medicaid Managed Care and Tailored Health Organizations payers as it relates to documentation and reimbursement requirements
Experience with Occupational, Speech, or Physical Therapy authorizations is preferred
Proficient in Microsoft and computer literacy
Highly Organized with a strong attention to detail
Ability to communicate well via electronic means (email, company chat, phone calls, zoom trainings)
Strong initiative to complete incoming tasks correctly
Flexible with the ability to adapt quickly to changes
Exhibits responsibility and professionalism
Driven to reach goals/targets
Positive outlook on life
Ability to start and foster relationships with our insurance providers and clinical staff members
Effective and efficient problem solver
Excellent attendance record and punctuality
Likes to work in a fast paced environment with others
Enjoys the pediatric population and their families
Desire to learn and advance skill set


Additional Benefits


Dental
Life Insurance
Retirement Savings



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