Facets Pre-Auth

Overview
Join our dynamic healthcare team as a Facets Pre-Authorization Specialist, where your expertise will be pivotal in streamlining the approval process for medical services and procedures. In this role, you will serve as a vital link between healthcare providers, insurance companies, and patients, ensuring that pre-authorization requests are processed efficiently and accurately. Your proactive approach and attention to detail will help facilitate timely access to care, improve patient satisfaction, and support our commitment to exceptional healthcare delivery. This paid position offers an exciting opportunity to grow within a fast-paced, mission-driven environment dedicated to making a difference in people's lives.

Responsibilities

• Review and verify insurance information, ensuring all necessary documentation is complete for pre-authorization requests.
• Collaborate with healthcare providers to gather required clinical information, including medical records and supporting documentation.
• Utilize Facets or similar healthcare management systems to submit and track pre-authorization requests efficiently.
• Communicate proactively with insurance carriers regarding status updates, additional requirements, or denials to facilitate swift resolution.
• Maintain accurate records of all pre-authorization activities, including correspondence and documentation for audit purposes.
• Ensure compliance with HIPAA regulations by safeguarding patient information during all stages of the authorization process.
• Assist with resolving issues related to managed care policies, insurance verification, and coding discrepancies such as CPT, ICD-9, ICD-10, and ICD coding.

Requirements

• Prior experience working in a medical office setting or dental office environment is highly preferred.
• Strong knowledge of managed care processes, insurance verification procedures, and medical billing/coding practices.
• Familiarity with medical terminology, medical records management, and healthcare compliance standards such as HIPAA.
• Experience with medical coding including CPT (Current Procedural Terminology), ICD (International Classification of Diseases) codes—ICD-9 and ICD-10—and ICD coding practices.
• Excellent organizational skills with the ability to manage multiple tasks accurately under tight deadlines.
• Office experience using electronic health records (EHR) systems or healthcare management software such as Facets is desirable.
• Knowledge of dental office operations or experience in dental insurance processing is a plus. Join us in delivering seamless healthcare experiences! Your dedication will help ensure patients receive the care they need promptly while supporting our team’s commitment to excellence in health services.

Pay: $29.07 - $65.01 per hour

Experience:

• UM/Pre-Auth : 5 years (Required)
• ITS/Authorization Routing Logic: 5 years (Required)
• Rule Traceability: 5 years (Required)

Work Location: Remote