Eligibility, Benefits, Prior Authorization Specialist

Job not on LinkedIn

🔥 12 hours ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Autism Diagnosis Group

WebsiteLinkedInAll Job Openings

2 - 10 employees

👥 B2C

B2C

Autism Diagnosis Group is a clinical service provider that delivers professional autism evaluations and diagnostic services for both pediatric and adult patients, now operating as Josi Health. They offer rapid, accessible telehealth-friendly assessments (including at-home evaluations), accept major insurance plans and provide self-pay options, and include care concierge, detailed reports, and follow-up debriefs to support patients and families across most U. S. states.

📋 Description

• Verify active patient insurance coverage, deductibles, co-pays, co-insurance, and coordination of benefits (COB) across commercial plans • Conduct in-depth research on payer-specific policies regarding virtual care, remote developmental pediatrics, and psychological evaluations (CPT 90791, 96130, etc.) • Navigate payor websites, newsletters, and provider manuals to track and document shifting policy guidelines and billing modifiers across 40+ states • Review incoming clinical diagnostic referrals and orders to ensure demographic, insurance, CPT, and ICD-10 data are flawless • Initiate, track, and validate prior authorizations through clearinghouses (e.g., Availity, Waystar), insurance portals, and phone escalations • Ensure all authorizations are secured, confirmed accurate, and fully documented in the EMR before the close of business each day for upcoming clinics • Act as the go-to resource for clinical teams when a payer's prior-authorization process is vague, contradictory, or unmapped • Validate conflicting information from multiple insurance sources to determine the most credible, risk-free path for claim submission • Build, update, and maintain internal state-by-state reference guides on commercial insurance and state-by-state regulatory requirements • Prepare clear, professional patient insurance benefit letters outlining estimated out-of-pocket costs and referral requirements • Collaborate closely with clinic coordinators and clinical staff to resolve last-minute scheduling exceptions or authorization gaps • Help de-escalate patient or provider concerns regarding coverage limits with professional, empathetic communication

🎯 Requirements

• 2+ years of healthcare clinic or startup experience specializing in insurance verification and prior authorizations • Strong research capabilities: deep comfort navigating payor portals, digging through policy manuals, and calling payor representatives to clarify ambiguous rules • Hands-on experience working with multiple major commercial payers (e.g., BCBS, Optum, Aetna) • Working knowledge of medical terminology, CPT, ICD-10, and telehealth billing modifiers • Excellent written and verbal English communication skills: ability to translate technical insurance terms into simple, clear explanations • High-speed internet, backup power setup, and the ability to work full-time during EST business hours

🏖️ Benefits

• 100% remote work from anywhere outside the US • Competitive monthly compensation in USD • The opportunity to join a fast-growing, mission-driven team with clear professional growth • Full access to modern operational tools and tech