Full-Time Senior Reimbursement Specialist - Prior Authorization

As a Senior Reimbursement Specialist, you will optimize billing operations and manage the full prior authorization lifecycle, ensuring timely approvals. You will streamline processes, resolve escalated reimbursement issues, and troubleshoot complex denials.

Key Responsibilities:

• Manage Prior Authorization Lifecycle: Independently handle the full prior authorization process.
• Optimize Billing Operations: Enhance billing efficiency in alignment with company goals.
• Resolve Reimbursement Issues: Address and troubleshoot complex denials and escalations.
• Facilitate Communication: Ensure seamless communication and efficient claim resolution.
• Maintain Accurate Documentation: Manage payer communications and insurance claims research.
• Develop Training & Quality Control: Contribute to the design and implementation of training programs.
• Collaborate with Offshore Teams: Work with teams handling prior authorization cases.
• Accurately enter and maintain data in computer systems.
• Verify and communicate insurance eligibility, billing and prior authorization details.
• Draft and submit written appeals.
• Interpret Prior Authorization Denials and Explanation of Benefits (EOBs).
• Adhere to HIPAA guidelines when providing medical records.
• Work effectively both independently and as part of a team.
• Perform other related duties as assigned.

Requirements:

• Minimum 5+ years experience in coding, billing, and prior authorization.
• Experience with contacting insurance carriers on denials and appeals.
• Experience working with a broad range of payers.
• Proficient in computer use, data entry, and MS Office including Excel.
• Familiarity with laboratory billing, Xifin, EDI enrollment, and payer portals.
• High school diploma or equivalent.

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