Full-Time Reimbursement Specialist - Prior Auth.

Reimbursement and Prior Authorization Specialist

Location: Remote, 3-Days Hybrid, and 5-Days Onsite Options

Shift: 9:00 AM - 5:30 PM CST, Monday - Friday

As a Reimbursement and Prior Authorization Specialist, you play an important role in driving payment. You will work with insurance companies to secure preauthorization for patient services.

Key Responsibilities

• Contact insurance companies to obtain preauthorization.
• Ensure information is accurate and complete.
• Follow up on requests.
• Apply knowledge of Medicare, Medicaid, and other payer requirements.
• Facilitate optimized billing processes.
• Develop and maintain a database of payer requirements.
• Manage payer communication and correspondence.
• Track, report, and address outstanding claims.
• Troubleshoot EOBs (Explanation of Benefits).
• Appeal non-covered and inappropriately adjudicated claims.
• Drive positive coverage determinations.

Requirements

• 3+ years of healthcare reimbursement experience.
• Knowledge of health plan regulations and processes.
• Moderate Excel skills (sorting, filtering, simple calculations).
• Experience working with a broad range of payers.
• Experience coordinating with insurance providers, physicians, and patients.
• Ability to work independently and with minimal supervision.
• Strong attention to detail.
• Excellent communication skills.
• Tech-savviness and analytical skills.

Preferred Skills

• Familiarity with laboratory billing, Xifin, EDI enrollment, merchant solutions, payer portals, and national/regional payers.
• Experience appealing to state/external level agencies (IRO/IRB).

Compensation

Hourly range: $24.15 - $36.25 USD (Palo Alto/Redwood City, CA). Specific pay is based on location and experience.

Work Environment

Hybrid work model: In-person/onsite collaboration days and work-from-home days.

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