Top 21 Prior authorization specialist Jobs in Durham Nc

Authorization and Appeals Specialist
The Palomino Group —Raleigh, NC
- From $23 an hour
- Full-time
- Hybrid work
- Background check
- Microsoft Excel
- Microsoft Outlook
- Disability insurance
- Health insurance
Quick Apply
8d
Billing and Prior Authorization Specialist
Central Dermatology Management Group, LLC —Durham, NC
- Hybrid work
- Writing skills
- Medical office experience
- Basic math
Quick Apply
9h
Utilization Review Specialist (Remote)
Coronis Health —Chapel Hill, NC
- $60,000 - $62,000 a year
- Full-time
- Remote
- LMFT
- Management
- Addiction Medicine
Quick Apply
14d
Authorization Specialist
Raleigh Medical Group PA —Raleigh, NC
- Full-time
- Customer service
- Medical office experience
- HIPAA
- Health savings account
- Disability insurance
Patient Access Specialist
McKesson —Cary, NC
- $15.93 - $26.55 an hour
- Hybrid work
- Computer literacy
- HIPAA
- Office
- Prescription drug insurance
7d
Health Services Specialist
McKesson —Cary, NC
- $17.99 - $29.98 an hour
- Hybrid work
- Mid-level
- Office
- 3 years
1d
Admissions Coordinator & Authorization/UR Specialist
Joshua Tree Health —Apex, NC
- Full-time
- HIPAA
- 3 years
- Data entry
Quick Apply
1d
Pharmacist :: Raleigh, NC
Software Technology Inc —Raleigh, NC
- Microsoft Excel
- Computer literacy
- Bachelor of Science
Quick Apply
Medical Front Desk Receptionist
US Foot & Ankle Specialists —Raleigh, NC
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid holidays
- Disability insurance
Quick Apply
Executive Care Coordinator
Valeris, Inc. —Raleigh, NC
- Full-time
- Bilingual
- Background check
- 5 years
- Health savings account
- AD&D insurance
Quick Apply
3d
Client Care Specialist - Full Time
FYZICAL Therapy and Balance Centers —Raleigh, NC
- $15 - $24 an hour
- Full-time
- High school diploma or GED
- Clinic
- Computer skills
- Paid holidays
- Health insurance
Quick Apply
Front Desk Receptionist
US Foot & Ankle Specialists —Cary, NC
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid holidays
- Disability insurance
Quick Apply
9d
Epic Ambulatory Bones Application Engineer Specialist - 6079188
Accenture —Raleigh, NC
- $47.85 - $57.85 an hour
- Full-time
- Remote
- 5 years
- High school diploma or GED
- US work authorization
- Disability insurance
- Health insurance
Office Coordinator/ Office Administrator
SV Medical Clinic —Apex, NC
- $16 - $21 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Employee discount
- Flexible schedule
Quick Apply
White Glove OEM Account Manager-2
Industrial Connections & Solutions LLC —Mebane, NC
- Full-time
- Mid-level
- Travel
- US work authorization
- Health savings account
- AD&D insurance
Quick Apply
2d

Discover related jobs

Based on your search for prior authorization specialist jobs.

PRN Infusion Nurse(RN)
Empowered Arthritis and Rheumatology Center PLLC —Cary, NC
Current, active, and unrestricted Registered Nurse (RN) license in the State of North Carolina (or a valid multistate/compact license).
$40 - $49 an hour
Quick Apply
7d
Infusion Registered Nurse (RN)
IVX Health —Durham, NC
Life Support Certifications – BLS certification required; PALS certification preferred. Active and Unrestricted Registered Nurse (RN) license.
Quick Apply

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Appeals-Billing Specialist | Patient Financial Services, Full-Time
Memorial Health Ohio —Marysville, OH
1 - 3 years of hospital billing & claim appeals and hospital reimbursement experience preferred; associate or bachelor’s degree preferred.
Quick Apply
Prior Authorization Specialist
WSD —Westerville, OH
Must have prior experience with insurances and prior authorizations. Collaborate with clinical staff to ensure timely approvals for patient treatments.
$18 - $25 an hour
Quick Apply
1d

Show more jobs in cities nearby

I want to receive the latest job alert for prior authorization specialist in durham nc

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

prior authorization specialist jobs near durham nc

Prior Authorization Specialist jobs in Durham, NC

Account Manager jobs in Mebane, NC

Executive Coordinator jobs in Raleigh, NC

Utilization Review Nurse jobs in Chapel Hill, NC

Medical Receptionist jobs in Raleigh, NC

Front Desk Receptionist jobs in Cary, NC

Authorization Specialist jobs in Raleigh, NC

Patient Access Specialist jobs in Cary, NC

Pharmacist jobs in Raleigh, NC

Office Administrator jobs in Apex, NC

Prior Authorization Specialist jobs in Washington, DC

Prior Authorization Specialist Remote jobs in California

Prior Authorization Pharmacy jobs in Florida

Prior Authorization Specialist jobs in Iowa

Prior Authorization Specialist jobs in Auburn Hills, MI

Prior Authorization Specialist jobs in Greensboro, NC

Program Manager jobs in Jacksonville, FL

Account Manager jobs in Baltimore, MD

Account Manager jobs in Tucson, AZ

Account Manager jobs in San Francisco Bay Area, CA

Authorization and Appeals Specialist

The Palomino Group
Raleigh, NC

Quick Apply

Job Details

Full-time
From $23 an hour
8 days ago

Benefits

Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Life insurance

Qualifications

Health insurance authorizations
Appeals
Microsoft Excel
Microsoft Outlook
Overseeing health insurance pre-certification
Medicare
Commercial insurance knowledge
Phone communication
Medical insurance coverage verification
HIPAA
Administrative experience
Medicaid health insurance
ICD-10
HCPCS
Phone customer support
Case appeal in utilization management
Attention to detail
Medical billing and coding communication with insurance companies
Health information regulatory compliance
Medical insurance appeals management
Organizational skills
Medicaid
Clinical confidentiality policies
Insurance claims appeal handling
Medical terminology

Full Job Description

Overview

The Authorization & Appeals Specialist will be responsible for conducting benefit and coverage verifications, obtaining authorizations, and supporting the appeal process for medical device procedures. The position will work as part of a reimbursement support team to obtain approval for patient procedures and will mainly interact with health insurance plans, healthcare providers in the physician practice and hospital outpatient settings, and patients. This position requires outstanding knowledge of the reimbursement process associated with outpatient medical procedures, including medical devices. This position requires exceptional written and verbal communication skills with healthcare providers and payers in addition to excellent customer service phone skills. Experience working within portals regarding the digital reimbursement setting is preferred. This is a remote position; however, some training at our Raleigh, NC facility is required.

A MINIMUM OF 2-3 YEARS OF AUTHORIZATION AND APPEALS SUPPORT EXPERIENCE REQUIRED.

Responsibilities

The Authorization & Appeals Specialist is responsible for coordinating the reimbursement process for medical device procedures and will work closely with health insurance companies, healthcare providers, and patients. This position requires frequent interaction with healthcare provider teams and requires demonstration of past work success within this or similar environments. Job duties include managing all aspects of the reimbursement and access process, including benefit and coverage verification, prior authorization, and appeals.

The Authorization & Appeals Specialist must be able to:

Understand insurance company processes pertaining to gaining authorization of treatment
Verify medical insurance benefits, including the ability to obtain and process payer forms
Provide information pertaining to claims, including billing and coding assistance
Coordinate authorization for medical device procedures with payer authorization departments
Support the various levels of appeal for denied authorizations or claims
Effectively communicate with healthcare providers on case status
Appropriately answer incoming calls, faxes, and emails through our reimbursement call center
Document all interactions and calls within a case management database
Maintain HIPAA compliance at all times
Expertly translate clinical information into a form letter
Work independently or within a team setting
Provide services in a high-volume and stressful work environment

Required Skill Set

The Authorization & Appeals Specialist must have prior experience in conducting authorizations and appeals for medical procedures and must possess the relevant knowledge of these processes across all payer types, including commercial and public health insurance plans.

Required skills include:

Prior success as an authorization and appeals specialists within the healthcare arena
Outstanding customer service skills (including clarity of voice, tone, empathy, and listening skills)
High level of Professionalism
Strong critical thinking and decision-making skills
Superior written communication skills
Excellent administrative skills
Ability to adapt to different situations
Strong organizational skills
Self-motivation with excellent follow-through skills
Ability to work independently with minimal-to-moderate supervision
Adaptive and flexible to new ideas and change
Proven/demonstrated knowledge of medical reimbursement methodologies
Understanding of HIPAA and legal requirements associated with health information
Fluency in medical terminology

Minimum Qualifications and Experience

3 years of experience conducting benefit and coverage verifications with health insurance plans
2-3 years of experience in conducting authorizations for medical procedures
2-3 years of experience in conducting appeals for medical procedures
3 years of health insurance experience working with HCPCS, CPT, ICD-10 codes
Demonstrated familiarity with all payer types (Medicare, Medicaid, Commercial, etc.)
Knowledge of medical procedures, including medical devices used in the outpatient setting
Associate degree or equivalent work experience
Technical Expertise: Working knowledge of Microsoft Office (Word, Excel, Outlook)

If you thrive in a detail-oriented environment with a passion for healthcare authorization and appeals administration, we invite you to bring your skills and enthusiasm to our team!

Pay: From $23.00 per hour

Benefits:

401(k)
Dental insurance
Disability insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Experience:

Prior Authorization and Appeals: 2 years (Preferred)

Location:

Raleigh, NC 27615 (Preferred)

Work Location: Hybrid remote in Raleigh, NC 27615

Quick Apply

Refine Your Search

prior authorization specialist jobs in durham nc

Authorization and Appeals Specialist

Billing and Prior Authorization Specialist

Utilization Review Specialist (Remote)

Authorization Specialist

Patient Access Specialist

Health Services Specialist

Admissions Coordinator & Authorization/UR Specialist

Pharmacist :: Raleigh, NC

Medical Front Desk Receptionist

Executive Care Coordinator

Client Care Specialist - Full Time

Front Desk Receptionist

Epic Ambulatory Bones Application Engineer Specialist - 6079188

Office Coordinator/ Office Administrator

White Glove OEM Account Manager-2

Discover related jobs

Explore jobs in cities nearby

I want to receive the latest job alert for prior authorization specialist in durham nc

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected