Employer Industry: Healthcare Services

Why consider this job opportunity:
- Salary up to $26.93 per hour based on experience, skills, and education
- Opportunity for career advancement and growth within a large not-for-profit healthcare system
- Full-time remote position with a day shift from 7:00 AM to 3:30 PM, Monday to Friday
- Supportive and collaborative work environment that values diversity and inclusion
- Chance to make a positive impact on patient care through effective authorization processes

What to Expect (Job Responsibilities):
- Submit and obtain authorization requests for designated specialty services
- Maintain expertise on payer authorization requirements to ensure proper authorization is obtained pre-procedure
- Review authorization denial trends and work with supervisors to address gaps leading to denials
- Obtain and track authorizations for new and existing patients according to their insurance policies
- Initiate Peer-to-Peer communications with payers to obtain letters of Medical Necessity

What is Required (Qualifications):
- Associate degree preferred
- Three or more years of experience in a healthcare environment with knowledge of patient populations and services
- Strong understanding of HIPAA laws and requirements related to documentation review and reporting
- Knowledge of managed care, third-party payer benefits, and reimbursement requirements
- Proficient in Microsoft Office applications, with preferred experience in EPIC or similar EMR systems

How to Stand Out (Preferred Qualifications):
- Certification in CCS, CCS-P, CPC, or specialty coding
- Experience in reviewing medical records for National Coverage Determinations (NCD) and Local Coverage Determinations (LCD)
- Ability to manage multiple priorities in a deadline-driven environment
- Previous medical office experience is preferred
- Strong communication skills with a focus on delivering exceptional customer service

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