Prior Authorization Specialist

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $17 - $19 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Labcorp

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1969

💼 Consulting

📦 Logistics

🏥 Healthcare

💰 Post-IPO Debt on 2019-06

Consulting • Logistics • Healthcare

Labcorp is a leading global life sciences company that provides comprehensive clinical laboratory and end-to-end drug development services. The company offers a wide range of diagnostic tests and services for patients, providers, and biopharmaceutical companies. Labcorp specializes in areas such as oncology, women's health, neurology, and genetics, offering both routine and specialized laboratory testing. It supports healthcare systems and organizations with clinical lab testing, health assessments, and employee wellness programs. Labcorp also plays a significant role in the biopharma sector, providing nonclinical research, central laboratory services, and consulting for drug development and commercialization. With their commitment to science and innovation, Labcorp aims to improve health and change lives worldwide.

📋 Description

• Review incoming orders to verify completeness and accuracy of documentation required for prior authorization submission • Initiate and manage prior authorization requests according to payer requirements and medical policies • Work with vendors, payers, and insurance representatives to facilitate prior authorization submissions • Monitor request status, track pending cases, and perform follow-up activities to support timely determinations • Review insurance policies, medical policies, and payer guidelines • Perform benefit investigations supporting reimbursement and pre-billing activities • Respond to billing inquiries through phone, email, chat, portal, and other channels • Provide authorization status updates and requirements information to providers, patients, and insurance representatives • Support resolution of authorization-related and billing-related issues • Maintain accurate records of prior authorization requests, approvals, denials, and related activities in designated systems • Enter and maintain authorization, coverage, and benefits information in applicable platforms • Identify process improvement opportunities related to authorization and reimbursement workflows • Participate in projects and initiatives supporting operational improvements and business objectives • Maintain productivity and service-level expectations while managing assigned schedules and changing priorities • Provide patient cost estimates • Partner with Sales, Operations, Billing, Laboratory teams, payers, providers, and patients to meet authorization and reimbursement requirements and support positive outcomes

🎯 Requirements

• High School or equivalent with minimum 2 years’ relevant experience • Successful completion of Labcorp training sessions including Medical Terminology, Anatomy and Physiology, along with passing the assessment of skill • Associate degree in Healthcare Administration, Business Administration, Health Information Management, or a healthcare-related field (preferred) • 1 or more years of experience in Clinical Laboratory Revenue Cycle Management (RCM) operations (preferred) • 1 or more years of experience supporting prior authorization, reimbursement, billing, or benefits verification activities within a clinical laboratory environment (preferred) • 1 or more years of experience using Microsoft Word, Microsoft Excel, and Microsoft Outlook in a healthcare reimbursement, billing, authorization, or revenue cycle environment (preferred) • Work remotely from a private, quiet workspace • Maintain a reliable high-speed internet connection with a minimum speed of 50 Mbps • Demonstrate customer service practices when supporting providers, patients, insurance representatives, and internal stakeholders • Communicate effectively through verbal and written communications across multiple communication platforms • Apply time management and organizational practices to manage workload and competing priorities • Maintain attention to detail when reviewing medical policies, insurance guidelines, documentation, and authorization requirements • Demonstrate knowledge of medical terminology, insurance guidelines, and healthcare regulations • Collaborate with team members and stakeholders to support process improvements and customer experience initiatives • Demonstrate initiative and flexibility when responding to changing business needs and priorities • Apply problem-solving practices in a fast-paced and evolving operational environment • Successfully pass a standardized color blindness test

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Life insurance • Short-term disability (STD) • Long-term disability (LTD) • 401(k) plan • Paid Time Off (PTO) or Flexible Time Off (FTO) • Tuition Reimbursement • Employee Stock Purchase Plan