Pre Authorization Specialist

  • Location
    Marlborough, California
  • Category
    Health Care - General
  • Job reference:
    US_EN_7_834155_2789797
  • Job Type
    Contract/Temporary

Pre-Authorization Specialist

Ajilon is looking to hire a Pre Authorization Specialist in Malborough, MA. This contract requires an individual who can reach far beyond with great analytical capabilities, interpersonal skills, and an excellent detail-oriented mentality and strong organizational skills. Apply now if you meet the qualifications!

Responsibilities:

The Pre-Authorization Specialist II is responsible for performing the initial benefit verification and pre-authorization functions with insurance carriers, within an established time frame, for new pre-surgical cases submitted to the Reimbursement Services Department. The Pre-Authorization Specialist II is responsible for providing competitive levels of support to the internal team, Health Care Professional offices, and sales representatives. They are also responsible for answering incoming calls received through the Reimbursement Services Department ACD line.

Key Responsibilities:
• Answers incoming calls received through the toll free Reimbursement Services ACD and provide appropriate call/case handling.
• Performs initial benefit verification and pre-surgical authorization for new pre-surgical cases by working closely with all payers
• Documents case status, actions, and outcome in the Reimbursement Services contact management database
• Communicates with HCP offices and sales representatives in regards to missing case information and upon approvals, as appropriate
• Works closely with the designated Reimbursement Specialists as it relates to benefit verification information received, questions about pre-authorization, payer issues, and case volume
• Responsible for notifying the appropriate internal departments based on receipt of information that department needs to be aware of including complaint handling/ adverse event notifications
• Utilizes customer service skills in engaging with customers, communications with Sales representatives, and working in teams in a call center environment to expedite processing of cases
• Responsible for working with Reimbursement Services Manager to develop and generate key reporting metrics and for making Intake process improvement recommendations

Experience and Education Requirements:
• MUST HAVE Previous experience in Insurance Pre-Authorization (not collections), or Medical device industry.
• Must be able to understand the complexities of the Insurance Reimbursement work flow and related processes.
• Must have basic understanding of Medicare, Medicaid, Private Payer, and Workers compensation coding, coverage, and payment as it relates to medical procedures, services, and devices
• Must possess strong computer skills including Microsoft Word and Excel. Experience in other applications such as PowerPoint and Publisher is a plus
• Type 40wpm minimum
• Must have exceptional organizational skills and keen attention to detail
• Must demonstrate the ability to effectively build relationships and communicate with both internal and external customers
• Must be able to accurately document and verbalize issues and have the ability to work with in a team environment and across departments
• Must be able to work in an environment where meeting and executing on timelines is essential. MUST be a team player
• Must be able to work in a fast pace environment in which information is constantly changing; must be able to embrace changes
• College undergraduate degree strongly preferred. Some college coursework required

If you feel you are qualified for this position, then apply today!



Equal Opportunity Employer/Veterans/Disabled

To read our Candidate Privacy Information Statement, which explains how we will use your information, please

The Company will consider qualified applicants with arrest and conviction records

Please apply with your CV to:

The Adecco Group North America family of brands has been named a 2019–2020 Great Place to Work®.

Your search. Our support.

When you work with us, we'll be by your side at every step of your search.

Resume assistance

Your resume needs to grab the attention of employers. We'll help yours stand out.

Interview coaching

The interview is your time to shine. With us, you'll be prepared and confident.

Career advancement

Keep your skills sharp and your career moving forward—that's what we do.

Excellent benefits

Health, dental, vision, 401k, work-life balance. You’ll get all the benefits you need.

Similar Jobs

Looking for something more?

Send us your resume and we'll do the searching for you.

Send Resume