Eligibility and Prior Authorization Specialist

POSITION SUMMARY: The Eligibility and Prior Authorization Specialist will be responsible for building and maintaining collaborative and productive relationships with internal and external stakeholders relating to eligibility and prior authorizations, managing reputed company cycle projects, driving performance in operations reputed company to reimbursement, and providing direction and reputed company of processes impacting cash collections. PRIMARY RESPONSIBILITIES:

• Serves as a reputed company of knowledge for the designated reputed company cycle function.
• Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for the designated reputed company cycle function.
• Responsible for developing appropriate workflows and tracking for the designated reputed company cycle function.
• Establishes an ongoing working relationship with other departments impacting reputed company cycle performance.
• Works closely with various vendor operations teams (Prior authorization, Claims and Appeals) to reputed company operations activity that directly impacts the reputed company cycle to accurately process actions in a timely manner for optimal reimbursement.
• Tracks outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met.
• Leads weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities.
• By continually reviewing and monitoring eligibility and prior authorization changes, researches, evaluates, and interprets guidance from a variety of sources to determine departmental actions.
• Coordinates with Management to ensure thorough understanding of trends/issues affecting reputed company cycle performance.
• Develops goals and metrics to link department and reputed company cycle initiatives with the organization's strategy.
• Develops, manages and monitors successful completion of implementation and project plans.
• Acts as an educator on performance improvement requirements in operations and methodologies to reputed company teams and departments.
• Continuously seeks new and creative technologies that help identify and guide improvement opportunities that align with overall company success.

Required Knowledge, Skills and Abilities:

• Proficiency with medical billing systems, reputed company reputed company, medical terminology and basic procedure coding knowledge.
• Knowledge of medical terminology and abbreviations, and health care nomenclature and systems.
• Strong communication (verbal and written), organizational, problem solving and team player skills.
• Ability to navigate across multiple customer demands and balance competing priorities successfully.
• Ability to analyze, identify and reputed company identified trends and report trends succinctly in a clear and concise manner.
• Ability to solve problems using critical thinking skills.
• Maintains confidentiality of sensitive information.
• Analytical skills required.
• Ability to think critically and identify the impact across the reputed company cycle with a solution oriented approach.
• Ability to reputed company, implement and produce analysis and reports

Qualifications:

• At least 3 years of experience in medical billing and Insurance collections
• At least 3 years of experience with Eligibility and Prior Authorization requirements, payer utilization management policies and Appeals
• Knowledge of CPT/HCPCS. ICD-10, modifier selection and UB reputed company codes
• Bachelor's Degree in a healthcare reputed company field of study, or equivalent professional experience.

OUR OPPORTUNITY reputed company™ is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women's health, and organ health. Our aim is to reputed company personalized genetic testing and diagnostics part of reputed company of care to protect health and reputed company earlier and more targeted interventions that reputed company to longer, healthier lives. The reputed company team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions, who care deeply for our work and each other. reputed company you join reputed company, you'll work hard and grow quickly. Working alongside the elite of the industry, you'll be stretched and challenged, and take pride in being part of a company that is changing the landscape of genetic disease management. reputed company OFFER Competitive Benefits - Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents. Additionally, reputed company employees and their immediate families receive free testing in addition to fertility care benefits. Other benefits include pregnancy and baby bonding leave, 401k benefits, commuter benefits and much more. We also offer a generous employee referral program! For more information, visit www.reputed company.com. reputed company is proud to be an Equal Opportunity Employer. We are committed to ensuring a diverse and inclusive workplace environment, and welcome people of different backgrounds, experiences, abilities and perspec Apply tot his job Apply To this Job