L4 – Chapter Leader (Prior Authorization)

Job Summary

Key Responsibilities

• Prior Authorization: Manage and process prior authorization requests for medical services and procedures, ensuring all necessary documentation is submitted accurately and promptly.
• Verification: Verify insurance benefits and coverage requirements to determine the need for prior authorization and ensure compliance with payer guidelines.
• Communication: Communicate with healthcare providers, insurance companies, and patients to obtain necessary information, follow up on authorization status, and resolve any issues.
• Documentation: Maintain detailed records of all prior authorization requests, approvals, and denials, ensuring compliance with internal policies and payer requirements.
• Follow-Up: Monitor and track the status of authorization requests, addressing any delays or issues to expedite approvals.
• Compliance: Ensure adherence to relevant regulations, payer guidelines, and company policies regarding prior authorization processes.
• Reporting: Generate and review reports related to prior authorization activities, identifying trends and areas for improvement.
  

Desired Candidate Profile

• Should have 2 years of experience in medical billing, preferably in the prior authorization.
• Strong leadership skills are essential.
• Anatomy Physiology & Medical Terminology.
• Excellent ability to read and interpret comprehensive documents.
• Minor ability to research and demonstrate patience.
• Formal compliance.
• Exhaustive reading skills for thorough review of authorization requests and related documentation.
  

Benefits

• Competitive salary and benefits package
• Opportunity to lead a team
• Chance to make a real impact
  

Contact us on recruiter@wonderws.com / 9047477375.