Prior Authorization Specialist - Verity Solutions - Remote

Job Description Summary

We are seeking a detailed-oriented and experienced Prior Authorization Representative.

The ideal candidate will have a strong background in prior authorization and operational tactics in a healthcare setting, with a focus on maintaining efficient prior authorizations.

This role is crucial for managing customer accounts, following medical and pharmacy plan guidelines, all while providing exceptional service to our clients.

Job Objective

This role follows detailed processes specific to obtaining pre-approval for clinical services such as infusion and injection medications provided in a medical practice setting.

Additionally, implements and supports specific client prior authorization services defining standardized and best practice workflows and tactics that ensure exceptional patient care.

Duties and Responsibilities:


* Perform medical and pharmacy benefit verification


* Review clinical documentation to ensure patients meet clinical criteria


* Submit prior authorization requests accurately and in a timely manner


* Follow up on prior authorization submissions to obtain written decisions from insurance


* Respond to customer requests in a timely manner


* Attend internal and external meetings


* Supports and promotes Verity Solutions values through positive interactions with both internal and external stakeholders on a regular basis


* Assist with training of new team members


* Attend to other team or cross-departmental initiatives as assigned

Experience, Skills and Qualifications:


* Advanced knowledge of HCPCs, CPT and ICD-10 codes


* High-level understanding of medical insurance, PBM, HCPCS codes, and HIPAA Compliance


* Ability to read and identify clinical documentation


* Knowledge of medical insurance requirements for various medical fields required.


* Experience working in insurance portals such as Availity


* Background in the field of Rheumatology, Allergy and/or Immunology is highly preferred


* Demonstrated ability to self-manage work prioritization between standard daily work activities and attending attend to critical client issues


* Able to prioritize tasks and work in a fast-paced environment


* Demonstrated ability to maintain professional demeanor and confidentiality


* Proven ability to use critical thinking and problem-solving skills to analyze and troubleshoot problems with customers


* Demonstrated interest in customer and colleague success through sharing knowledge, ideas, tips and experiences


* Proven ability to communicate verbally and in written form at a high level


* Ability to multitask and manage multiple discreet patient records at the same time


* Visible enthusiasm for on-going learning


* Role models a passion for working with customers, proactive problem-solving and troubleshooting, and embodying a culture to exceed expectations

If you will be working at home occasionally or perma...