Description

We are looking for a Prior Authorization Specialist to join our telemedicine team. In this role, you will serve as subject matter expert for members, providers, and internal departments to promote an understanding of Prior Authorization requirements and processes. You must be comfortable speaking with others across various channels (email and phone) compassionately and professionally.

Key Responsibilities for the Prior Authorization Specialist:

• Screens and prioritizes incoming Prior Authorization requests.
• Supports clinical staff (nurses, physicians, etc.) involved in the Prior Authorization process.
• Processes incoming requests, including completing the authorization for specific and limited services, based on established guidelines.
• Forwards authorization requests that require clinical judgment to Prior Authorization nurse, Manager, or Medical Director.
• Maintains a full caseload while meeting or exceeding designated metrics and turn-around timeframes.
• Answers inbound calls from providers and other departments, verifies member eligibility and enters the information necessary to complete the caller’s request into the designated database.
• Identifies and inform callers of network providers, services, and any other available member benefits.
• Informs providers of the decision on their requests, per department procedure.
• Assist with the resolution of escalated member or provider inquiries related to Prior Authorization.

Benefits for the Prior Authorization Specialist:

• The ability to make a difference in the healthcare technology industry!
• Flexible, portable individual medical plan options with generous employer contributions
• Group dental and vision plan with 99% SureCo paid coverage
• Generous annual reimbursement allowance for employee health-related expenses
• SureCo paid Ancillary benefits such as basic life, short-term and Long-term disability insurances
• Complimentary employee assistance program (EAP)
• Concierge Services such as?Beneficiary Assist, Travel/ID Protection, College Tuition Rewards, and much more

Requirements

• Requires a HS diploma or GED; Associate’s or bachelor's degree is a plus.
• Preferred, but not required, a Certified Nurse Assistant (CNA) or Medical Assistant (MA).
• Requires exceptional phone/customer service skills, as well as strong computer user skills.
• Required 2 years of Prior Authorization, Claims, Utilization Review, or Care Coordination experience.
• Required 1 year at a Managed Care Organization (Health Plan, IPA/Medical Group, HMO, TPA/MSO, etc.).
• Requires basic to intermediary familiarity with Medical terminology (1-3 years direct experience).
• Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
• Knowledge of health care delivery system, Medicaid/Medicare and related state programs is required.
• Computer skills include Microsoft Word, Excel, and basic data entry, including the ability to learn new and complex computer system applications.
• Must have a minimum of 30-40 wpm typing with a high level of accuracy.

About SureCo

SureCo is at the forefront of healthcare transformation. We have built a platform that offers robust healthcare options and medical management services while reducing costs through technological and product innovations. We are leading the healthcare industry in new care options, innovative technology, and robust administration tools. We launched the business in 2015 working together to manage and foster our explosive growth. Come join an exciting organization that thrives on new ideas and fosters an environment of innovation through team building & support.

Our business is fast-paced and will continue to evolve. As such, the duties and responsibilities of this role may be changed as directed by the Company at any time to promote and support our business needs.

SureCo is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, protected veteran status, or any other basis protected by applicable law and will not be discriminated against on the basis of disability.