Prior Authorization Specialist

Company Description:

At UpScript Health, we believe patients deserve access to medications through experiences that work for them. Our proprietary, best-in-class technology allows patients to participate in personal health screenings, consult with physicians or nurse practitioners, utilize insurance benefits for medications when appropriate, and receive home delivery of medications. All of this is done in an easy, quick, and discrete process.

This is a chance to work in a great environment and be a part of a progressive organization dedicated to the well-being of our patients and team members and a leader in the field of telehealth and patient care.

Job Overview:

We are seeking a highly skilled and detail-oriented Prior Authorization & Referral Management Specialist to join our dynamic tele-healthcare team. This individual will play a critical role in managing the prior authorization process, referral coordination, and insurance-related communications. The ideal candidate will have experience working with prior authorization systems, collaborating with insurance providers, and coordinating care for patients, ensuring that all medication and treatment plans are aligned with insurance requirements.

Key Responsibilities:

• Submit and manage prior authorization requests through CoverMyMeds and payer portals
• Document all activity accurately and thoroughly in Salesforce
• Monitor PA status and proactively follow up with insurance companies
• Communicate with patients both verbally and in writing to explain prior authorization processes, answer questions, etc.
• Coordinate with pharmacies to resolve claim rejections
• Track denials and prepare appeals as needed
• Maintain compliance with HIPAA and all regulatory requirements
• Identify workflow improvements to increase efficiency and approval rates
• Collaborate with teammates to ensure timely and accurate completion of tasks.

Qualifications:

● Minimum of 2 years of patient support experience in the healthcare industry.

● Proven experience with prior authorization systems (Cover My Meds, PromptPA, SureScripts, etc.).

● Strong understanding of insurance benefit investigations, prior authorization processes, and status follow-up.

● Previous experience in a healthcare setting, with a solid understanding of HIPAA, medical records, documentation, and healthcare terminology.

● Proficiency in EMR systems (e.g., Athena, Salesforce) and experience working with multiple healthcare software platforms.

● Comfortability with Google Workspace (Drive, Sheets, Docs, Help Center, Email), Slack, and other web-based tools for communication and record-keeping.

● Experience with a multi-phone system, handling both incoming and outgoing calls effectively.

● Ability to communicate with patients clearly, empathetically, and professionally, both verbally and in writing.

● Excellence in documenting medical records, ensuring clarity, accuracy, and compliance.

● Ability to work collaboratively with teammates, communicating effectively to meet patient and team needs.

● Strong organizational skills with the ability to prioritize and manage multiple tasks.

● Willingness to ask for help when needed to ensure tasks are completed effectively and efficiently.

Preferred Skills:

● Experience in a fast-paced, high-volume healthcare environment.

● Familiarity with insurance policies, billing codes, and healthcare compliance.

● Self-directed with an ability to manage competing priorities while maintaining a focus on patient care and service.

Why Join Us:

● Opportunity to work with a collaborative and compassionate team.

● Competitive salary and benefits.

● Professional growth and development opportunities.

● Flexible working arrangements in a supportive work environment.

● Paid vacation, sick time

● Company supported health, dental, vision and life insurance

● 401k with 4% company match after 6 months

Job Type: Full-time

Pay: $21.00 - $22.00 per hour

Benefits:

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

Location:

• Remote (Required)

Work Location: Remote