Eligibility and Prior Authorization Specialist

Job Summary

To support revenue cycle operations, the remote Eligibility and Prior Authorization Specialist will manage relationships with stakeholders, analyze performance trends, and oversee processes impacting cash collections on a temporary basis.

Key responsibilities:

• Serve as a knowledge source for revenue cycle functions and establish collaborative relationships across departments
• Perform analysis to identify trends and prioritize initiatives for performance improvement in eligibility and prior authorization
• Coordinate with vendor operations teams to ensure timely processing of actions that affect reimbursement

Required 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 and payer utilization management policies
• Knowledge of CPT/HCPCS, ICD-10, modifier selection, and UB revenue codes
• Bachelor's degree in a healthcare-related field or equivalent experience