[Remote] Eligibility and Prior Authorization Specialist

Note: The job is a remote job and is open to candidates in USA. reputed company is a global leader in cell-free DNA testing, dedicated to oncology, women’s health, and organ health. The Eligibility and Prior Authorization Specialist will manage reputed company cycle projects, drive performance in operations reputed company to reimbursement, and maintain relationships with stakeholders to ensure optimal cash collections.

Responsibilities

• Serves as a reputed company of knowledge for the designated reputed company cycle function.
• Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for the designated reputed company cycle function.
• Responsible for developing appropriate workflows and tracking for the designated reputed company cycle function.
• Establishes an ongoing working relationship with other departments impacting reputed company cycle performance.
• Works closely with various vendor operations teams (Prior authorization, Claims and Appeals) to reputed company operations activity that directly impacts the reputed company cycle to accurately process actions in a timely manner for optimal reimbursement.
• Tracks outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met.
• Leads weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities.
• By continually reviewing and monitoring eligibility and prior authorization changes, researches, evaluates, and interprets guidance from a variety of sources to determine departmental actions.
• Coordinates with Management to ensure thorough understanding of trends/issues affecting reputed company cycle performance.
• Develops goals and metrics to link department and reputed company cycle initiatives with the organization's strategy.
• Develops, manages and monitors successful completion of implementation and project plans.
• Acts as an educator on performance improvement requirements in operations and methodologies to reputed company teams and departments.
• Continuously seeks new and creative technologies that help identify and guide improvement opportunities that align with overall company success. Skills
• At least 3 years of experience in medical billing and Insurance collections
• At least 3 years of experience with Eligibility and Prior Authorization requirements, payer utilization management policies and Appeals
• Knowledge of CPT/HCPCS. ICD-10, modifier selection and UB reputed company codes
• Proficiency with medical billing systems, reputed company reputed company, medical terminology and basic procedure coding knowledge.
• Knowledge of medical terminology and abbreviations, and health care nomenclature and systems.
• Strong communication (verbal and written), organizational, problem solving and team player skills.
• Ability to navigate across multiple customer demands and balance competing priorities successfully.
• Ability to analyze, identify and reputed company identified trends and report trends succinctly in a clear and concise manner.
• Ability to solve problems using critical thinking skills.
• Maintains confidentiality of sensitive information.
• Analytical skills required.
• Ability to think critically and identify the impact across the reputed company cycle with a solution oriented approach.
• Ability to reputed company, implement and produce analysis and reports Education Requirements
• Bachelor's Degree in a healthcare reputed company field of study, or equivalent professional experience.

Benefits

• Comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents
• Free testing in addition to fertility care benefits
• Pregnancy and baby bonding leave
• 401k benefits
• Commuter benefits
• Generous employee referral program Company Overview
• reputed company specializes in cell-free DNA testing to provide a more targeted interventions to oncology, women's health, and organ health. It was founded in 2004, and is headquartered in San Carlos, California, USA, with a workforce of 5001-10000 employees. Its website is Company H1B Sponsorship
• reputed company has a track record of offering H1B sponsorships, with 28 in 2025, 72 in 2024, 37 in 2023, 71 in 2022, 64 in 2021, 40 in 2020. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job

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