Job Overview
We are seeking a dedicated and detail-oriented Patient Authorization Representative to join our healthcare team. In this vital role, you will serve as the key liaison between patients, healthcare providers, and insurance companies to facilitate timely and accurate authorization for medical services. Your expertise will ensure compliance with healthcare regulations, including HIPAA, while streamlining the authorization process to support optimal patient care. This position offers an exciting opportunity to make a meaningful impact by navigating complex insurance policies and medical documentation with professionalism and efficiency.
Responsibilities
- Run benefit eligibility checks to confirm coverage, cost-share, and authorization requirements before care begins
- Keep eligibility status accurate and current for every active member in our systems
- Obtain necessary prior authorizations from insurance companies by submitting detailed requests that include relevant medical records, clinical documentation, and supporting information.
- Communicate effectively with healthcare providers to gather additional clinical information needed for authorization approval while maintaining strict adherence to clinical confidentiality policies.
- Verify patient insurance coverage and eligibility using electronic health records (EHR) systems and other electronic health records management tools.
- Track and document all authorization requests, approvals, denials, and follow-up actions within medical records systems to ensure accurate recordkeeping and compliance.
- Collaborate with billing departments to resolve authorization-related billing issues promptly, ensuring smooth reimbursement processes.
- Maintain up-to-date knowledge of health insurance policies, industry regulations, and coding standards to improve accuracy and efficiency in authorization procedures.
Requirements
- Benefits & Eligibility
- Run benefit eligibility checks to confirm coverage, cost-share, and authorization requirements before care begins
Prior Authorization
- Manage medical prior authorization requests, renewals, and extensions across payers and specialty pharmacy partners end to end
- Prepare and submit PA documentation, track approval status, and escalate stalled or denied authorizations before they delay care
Document & Order Follow-Up
- Chase down unsigned documents and orders—following up proactively with provider offices so nothing stalls in limbo
- Process incoming referrals, faxes, and clinical documents, routing each to the right place
Staffing & Shipping Coordination
- Coordinate clinical staffing with staffing agencies to ensure providers are in place for each member's treatment
- Coordinate medication shipping with pharmacy partners so the right therapy arrives at the right time
Inbound Call Support
- Answer inbound calls from providers, pharmacy partners, and occasionally members, triaging and routing each inquiry to the right team member
- Document call details accurately and follow through on any action items
- Represent Leap with professionalism and a service-oriented approach on every call
Documentation & Compliance
- Collect, organize, and store member records and clinical documentation accurately and on time
- Ensure all files meet internal standards and HIPAA compliance requirements
- Keep eligibility status accurate and current for every active member in our systems
Pay: From $63,000.00 per year
Benefits:
Experience:
- healthcare benefits: 3 years (Required)
- healthcare elegibility: 3 years (Required)
- patient authorization : 3 years (Required)
Work Location: Remote
