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As a Clinical Prior Authorization Specialist, you will play a critical role in our healthcare team. Your primary responsibility will be to review and process prior authorization requests for medical services and medications. You will ensure that all requests meet the necessary clinical guidelines and payer requirements, facilitating timely access to care for our patients.

Job Responsibilities:

Review and process prior authorization requests for medical procedures, treatments, and medications.
Verify patient eligibility and benefits with insurance payers.
Ensure that all prior authorization requests comply with clinical guidelines and payer policies.
Communicate with healthcare providers, insurance companies, and patients to gather necessary information and resolve any issues.
Maintain accurate and detailed records of prior authorization requests and outcomes.
Utilize electronic health records (EHR) and prior authorization software to track and manage requests.
Stay current with industry regulations, payer policies, and clinical guidelines to ensure compliance.
Provide support and guidance to healthcare providers and staff regarding prior authorization processes and requirements.

Requirements:

A degree or certification in a healthcare-related field (e.g., nursing, pharmacy, medical billing and coding).
Proven experience in a clinical or prior authorization role, preferably in a remote setting.
Strong understanding of medical terminology, clinical guidelines, and insurance payer policies.
Excellent communication and interpersonal skills.
Detail-oriented with strong organizational and time-management abilities.
Proficiency in using electronic health records (EHR) systems and prior authorization software.
Ability to work independently and manage a high volume of authorization requests.
Flexibility to adapt to changing payer requirements and industry standards.

Benefits:

Remote work flexibility, allowing you to work from anywhere.
Competitive salary and performance-based incentives.
Comprehensive benefits package, including health, dental, and vision insurance.
Opportunities for professional development and continuing education.
Supportive and collaborative team environment.

If you are passionate about improving patient care and have the skills and experience we are looking for, we would love to hear from you! Please submit your application along with your resume and cover letter.

Clinical Prior Authorization Specialist – Remote

Clinical Prior Authorization Specialist – Remote

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