Payer Authorization Operations Associate

🕒 5 dias atrás

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Abby Care

SiteLinkedInTodas as Vagas

51 - 200 funcionários

🏥 Saúde

📦 Logística

💼 Consultoria

Healthcare • Logistics • Consulting

A Abby Care é um serviço que ajuda famílias a serem remuneradas por fornecerem cuidados domiciliares a entes queridos com deficiências ou necessidades especiais. A organização oferece treinamento e certificação gratuita para cuidadores familiares, gerencia contratações e folha de pagamento, orienta em relação à papelada do Medicaid e de seguros para garantir o pagamento, além de proporcionar uma plataforma desenvolvida para esse fim, suporte clínico e recursos comunitários. A Abby Care opera em vários estados dos EUA e se concentra em possibilitar o cuidado familiar de alta qualidade e remunerado, por meio de parcerias com seguradoras e programas Medicaid.

Descrição

• Collect, review, validate, and track documentation required for payer authorizations and re-authorizations • Prepare and submit complete authorization packets before expiration to prevent interruptions in patient care • Ensure documentation meets Medicaid, Medicare, payer, and state-specific requirements • Maintain accurate documentation and records across internal systems • Serve as a primary point of contact for families and caregivers regarding authorization status, documentation requirements, and benefit questions • Manage approximately 50–70 inbound and outbound calls daily • Respond to phone, email, and text inquiries and ensure timely follow-up • Monitor authorization timelines and proactively identify upcoming expirations • Prioritize competing requests while maintaining high accuracy and service levels • Identify documentation issues and partner with internal teams to resolve them • Collaborate with Onboarding, Credentialing, Family Support, Clinical Operations, and other internal teams • Escalate complex authorization issues when appropriate • Contribute to process improvements that increase efficiency and reduce authorization delays

🎯 Requisitos

• 2+ years of experience in healthcare operations, healthcare administration, customer service, or administrative support • Experience managing prior authorizations, payer documentation, or healthcare operations • Proven success handling high-volume inbound and outbound calls in a fast-paced environment • Experience managing documentation with exceptional accuracy and attention to detail • Familiarity with HIPAA, Medicaid, Medicare, or healthcare documentation standards • Experience using CRM systems and collaboration tools such as Salesforce, Slack, Google Workspace, or similar platforms • Strong organizational and time-management skills with the ability to prioritize multiple competing deadlines • Excellent written and verbal English communication skills • Employment contingent upon successful completion of a background check, satisfactory references, and any required documentation • Ability to work Monday–Friday, 9:00 AM–5:00 PM Eastern Time

🏖️ Benefícios

• Annual company performance bonus eligibility for global team members • 15 days of paid time off • 10 paid company US holidays • Growth opportunities and leadership-skill development • Remote work arrangement