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

• Dental
• Life Insurance
• Retirement Savings