About the Role
The role involves researching and validating healthcare service authorizations, verifying patient and provider information, and ensuring adherence to policies and procedures.
Responsibilities
- Investigate and confirm authorization requirements for medical services
- Review patient eligibility and benefits details
- Validate provider credentials and licensing status
- Analyze documentation for compliance with regulatory guidelines
- Support accurate processing of pre-authorization requests
- Identify discrepancies in verification data
- Collaborate with internal teams to resolve issues
- Maintain up-to-date knowledge of healthcare regulations
- Ensure timely follow-up on pending authorizations
- Prepare summaries of verification findings
- Communicate with external parties to obtain missing information
- Track case progress through verification systems
- Escalate complex cases according to protocols
- Follow established workflows for consistency
- Maintain data privacy and confidentiality
- Respond to inquiries related to verification status
- Assist in improving research processes
- Document actions taken during investigations
- Verify insurance coverage details
- Support coordination between clinical and administrative units
Compensation
Competitive salary based on experience
Work Arrangement
Remote with flexible scheduling options
Team
Collaborative team focused on operational accuracy and patient care support
Research Focus
- Primary focus on validating service authorizations and provider credentials
- Ongoing analysis of regulatory changes affecting verification processes
Performance Expectations
- Meet accuracy benchmarks for verification tasks
- Maintain timely case resolution rates
Not available for this position
