Prior Authorization Team Lead

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $23 / hour

⏰ Full Time

🟠 Senior

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Point Health

WebsiteLinkedInAll Job Openings

1 - 10 employees

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare Insurance • Healthcare • Wellness

Point Health is a healthcare company that specializes in providing treatment solutions for chronic pain management. They collaborate with top-rated physicians and clinics to offer next-day appointments, making it easier for patients to access care. By leveraging a multidisciplinary approach, Point Health aims to provide effective pain management strategies while ensuring a seamless experience for patients, including the option for insurance evaluations and minimal wait times.

📋 Description

• Collect and review documentation required for prior and retro authorization requests. • Review payer medical necessity guidelines and authorization requirements. • Communicate with practices to obtain additional information needed for procedures and medication requests. • Navigate payer portals and monitor provider and clinic communications to ensure timely responses. • Document account activity and maintain accurate patient and claim information. • Monitor procedure trackers and assist leadership in identifying workflow gaps. • Serve as a subject matter expert on medical policies, departmental procedures, and affiliate workflows. • Lead team huddles, distribute meeting notes, and assist with team training, mentoring, audits, and cross-coverage. • Support new practice and procedure integrations, including workflow and SOP development. • Identify authorization trends or issues that may delay claims processing and recommend solutions. • Collaborate with practices, vendors, insurance carriers, patients, management, and internal teams. • Provide outstanding customer service and support throughout the department. • Perform other related duties as assigned.

🎯 Requirements

• High School Diploma or GED required. • At least one (1) year of prior authorization experience in a clinical setting required. • Excellent verbal and written communication skills. • Strong organizational, analytical, and problem-solving abilities. • Proficiency with Microsoft Office Suite or similar software. • Extensive knowledge of medical policies and LCDs related to pain management procedures. • Basic understanding of medical terminology. • Experience navigating payer portals to obtain authorizations and review medical policies.

🏖️ Benefits

• Health, Dental & Vision Insurance • Accident and Life/AD&D Insurance • Short & Long-Term Disability • Emergency Travel Assistance Program • ID-Theft Protection Services • Health Savings Account (HSA) • Health Management Tools • Paid Time Off (PTO) • Company Paid Holidays • Paternal Leave • 401(k) • Remote Stipend • Travel Reimbursement • Continuing Education Reimbursement • Bonusly Employee Recognition Platform • DailyPay On-Demand Pay Access • LifeMart Employee Discount Program