Prior Authorization Specialist (Orthopedic) ID-5035

December 27, 2024

Description

MedCore Solutions, the healthcare division of Bizforce, is seeking a skilled Prior Authorization Specialist to join our growing team. The Prior Authorization Specialist is primarily responsible for obtaining all prior authorizations. These prior authorizations include biologic medications, procedures, prescriptions, and outpatient testing. The position will require professional and courteous interaction with patients, pharmaceutical representatives, providers, pharmacies and insurance carriers to accurately obtain the required information to process prior authorizations.

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Responsibilities:

Review and process prior authorization requests for medical services, procedures, and medications
Verify insurance (pharmacy) information and eligibility
Handle patient inquiries regarding authorizations
Provide necessary prior authorization documentation to patients for completion and signature. Review all forms for completeness and accuracy.
Accurately document all patient, pharmacy and insurance carrier interactions in EMR.
Coordinate with healthcare providers and insurance companies to obtain necessary authorizations
Ensure accurate and timely documentation of authorization requests and approvals
Collaborate with medical billing team to resolve any issues or denials
Maintain up-to-date knowledge of insurance guidelines and procedures
Complete other tasks as assigned by providers through EMR/EHR
Copy, fax and mail documents and information as requested by insurance carrier
Schedule follow-up appointments, biologic injections and photodynamic therapy treatments
Assist pathology department with notifying patients of pathology results via telephone
Fulfill organizational responsibilities as assigned, which may include but are not limited to: respecting and promoting patient’s rights, responding appropriately to emergency situations, sharing problems relating to patients and/or staff with Care Center Leader in a timely manner
Provide safe patient-centered, compassionate, and competent care

Requirements

Proven 3-5 years of experience as a Prior Authorization Specialist in the US Healthcare
Strong understanding of medical billing and insurance processes
Excellent communication and interpersonal skills
Detail-oriented with strong organizational skills
Ability to work independently and meet deadlines
Comfortable working in a remote, work-from-home setup
Average English communication skills
Amenable to work in a graveyard shift

System Requirements

Device (Desktop or Laptop)

Processor:
- Windows Devices: Intel Core i5 (or higher) or AMD Ryzen 5 (or higher).
- Mac Devices: Apple M1 chip or newer.
RAM:
- Minimum of 8GB or higher for optimal performance.
Operating System:
- Windows: Windows 11 Pro (Windows 10 Pro is acceptable but not preferred). The operating system must have a legitimate license.
- Mac: macOS compatible with M1 or newer chips.
Hard Disk:
- At least an SSD for faster processing and performance.
Internet Connectivity:
- Minimum speed of 50 Mbps via a wired connectionfor stability and reliability.
- A backup internet connection is highly recommended.

*Power Supply:

A backup power supply (e.g., UPS or generator) to prevent disruptions during power outages (optional but encouraged)

Benefits

Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.

Permanent Work From home
Permanent Weekends Off
Great Company Culture and No Micromanagement
Annual Bonus

Who We Are

MedCore Solutions (MCS) is a single-source solution for Healthcare administration. MCS is an industry leader in medical billing, credentialing, scribing, insurance verification, compliance, and virtual staffing.

We offer an expansive suite of administrative products and training to keep your practice and its employees safe and up-to-date with compliance and to avoid fines and litigation. Our online compliance center is quick and easy to use and provides you with an extensive library of training courses, covering OSHA, HIPAA, Human Resources, Health Plan Management, Patient Safety and Regulations, Infection Control, and much more.

Prior Authorization Specialist (Orthopedic) ID-5035

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

DISCLAIMER

Other Jobs You May Be Interested In

Prior Authorization Specialist (Orthopedic) ID-5035

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

5. HOW DO YOU PROCESS INFORMATION?

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

8. HOW TO PRIORITIZE WORK?

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

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